Division of Cardiology, Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine, Tohon, Ehime, 791-0295, Japan.
Int J Cardiol. 2013 Aug 10;167(3):1000-5. doi: 10.1016/j.ijcard.2012.03.079. Epub 2012 Apr 4.
An impaired myocardial perfusion state after primary angioplasty is a strong predictor of long-term adverse outcomes in patients with STEMI. We assessed the relationship between culprit plaque characteristics and myocardial perfusion state after primary angioplasty in patients with ST-segment elevation myocardial infarction (STEMI).
A total of 101 consecutive patients with de novo STEMI were divided into 3 groups according to the state of myocardial perfusion assessed by ST-segment elevation resolution (STR): Group A (complete: STR ≥ 70%, n=26), Group B (partial: STR<70% but ≥ 30%, n=55) and Group C (none: STR<30%, n=20). We analyzed plaque features by virtual histology intravascular ultrasound (VH-IVUS) and assessed the relationship between culprit plaque characteristics and STR after primary angioplasty.
Total plaque volume was significantly higher in Group C than in Groups A and B (146.4 ± 38.0 mm(3)vs. 93.3 ± 29.1 mm(3) and 105.8 ± 31.5 mm(3), p<0.001, respectively). Necrotic core (NC) volume was also significantly higher in Group C than in Groups A and B (25.4 ± 8.0m m(3), vs. 11.9 ± 6.3 mm(3) and 17.3 ± 9.7 mm(3), p<0.001, respectively). Analysis of receiver-operating characteristic curves revealed that total plaque volume and NC volume had the best diagnostic accuracy of all the VH-IVUS parameters to predict STR<30%. The optimal cutoff values (sensitivity/specificity) were 123.4 mm(3) (75.0%/75.3%) for total plaque volume and 20.3mm(3) (75.0%/74.1%) for NC volume.
Culprit plaque with large plaque burden and high NC volume is closely associated with poor STR after revascularization.
经皮冠状动脉介入治疗（PCI）后心肌灌注受损是 ST 段抬高型心肌梗死（STEMI）患者长期不良预后的强有力预测因子。本研究评估了初发 STEMI 患者罪犯斑块特征与 PCI 后心肌灌注状态之间的关系。
共纳入 101 例初发 STEMI 患者，根据 ST 段抬高缓解（STR）评估的心肌灌注状态分为 3 组：A 组（完全缓解：STR≥70%，n=26）、B 组（部分缓解：STR＜70%但≥30%，n=55）和 C 组（无缓解：STR＜30%，n=20）。通过虚拟组织学血管内超声（VH-IVUS）分析斑块特征，并评估罪犯斑块特征与 PCI 后 STR 的关系。
C 组总斑块体积明显大于 A 组和 B 组（146.4±38.0mm³比 93.3±29.1mm³和 105.8±31.5mm³，p＜0.001）。C 组坏死核（NC）体积也明显大于 A 组和 B 组（25.4±8.0mm³比 11.9±6.3mm³和 17.3±9.7mm³，p＜0.001）。ROC 曲线分析显示，总斑块体积和 NC 体积是 VH-IVUS 参数中预测 STR＜30%的最佳诊断准确性。总斑块体积的最佳截断值（敏感性/特异性）为 123.4mm³（75.0%/75.3%），NC 体积的最佳截断值为 20.3mm³（75.0%/74.1%）。
罪犯斑块具有较大的斑块负荷和较高的 NC 体积，与血运重建后 STR 不良密切相关。
