Department of Cardiology, Takase Clinic, Takasaki, Japan.
JACC Cardiovasc Interv. 2012 Jun;5(6):636-43. doi: 10.1016/j.jcin.2012.02.016.
This study sought to identify whether computed tomographic angiographic (CTA) plaque characteristics are associated with slow-flow phenomenon (SF) during percutaneous coronary intervention (PCI).
SF during PCI is associated with myocardial damage and prolonged hospitalization. Intracoronary ultrasound-verified large echolucent lesions have been reported to predict SF.
The authors evaluated pre-PCI CTA plaque characteristics in 40 consecutive patients (male/female, 31/9; age, 69 ± 10 years) with stable angina pectoris who developed SF during PCI; patients with ≥ 600 Agatston coronary artery calcium score were not included. They were compared with 40 age-, sex-, and culprit coronary artery-matched patients (male/female, 31/9; age, 69 ± 9 years) who underwent PCI during the same period and did not develop SF. Plaque characteristics, including vascular remodeling, plaque consistency, including low-attenuation plaques representing lipid-rich lesions and high-attenuation plaque patterns of calcium deposition, were analyzed.
Calcium deposition in the perimeter of a plaque, or circumferential plaque calcification (CPC), was significantly more frequent in the SF group (25 of 40, 63%) than the no-SF group (2 of 40, 5.0%) (p < 0.001). Presence of CPC on CTA was confirmed at the same location in the nonenhanced CT during Agatston coronary artery calcium score calculation. The positive remodeling index was significantly higher (1.5 [1.3 to 1.8] vs. 1.2 [1.0 to 1.5]; p < 0.001) and plaque density significantly lower (23.5 [9.5 to 40] HU vs. 45 [29 to 86] HU; p = 0.001) in the SF group. The conditional logistic regression analysis revealed that CPC, plaque density, and dyslipidemia were the predictors of SF, with CPC being the strongest (odds ratio: 79; 95% confidence interval: 8 to 783, p < 0.0001).
CTA-verified CPC with low-attenuation plaque and positive remodeling were determinants of SF during PCI. If CTA findings are available in patients undergoing PCI, the interventionists should be aware of the likelihood of SF.
本研究旨在探讨计算机断层血管造影（CTA）斑块特征是否与经皮冠状动脉介入治疗（PCI）中的慢血流现象（SF）相关。
PCI 过程中的 SF 与心肌损伤和住院时间延长相关。已有研究报道，经冠状动脉内超声证实的大回声不均匀病变可预测 SF。
本研究纳入了 40 例连续的稳定性心绞痛患者（男/女，31/9；年龄 69±10 岁），这些患者在 PCI 过程中出现 SF，但冠状动脉 CT 血管造影（CTA）检查排除了≥600 分的冠状动脉钙积分。这些患者与同期进行 PCI 且未发生 SF 的 40 例年龄、性别和罪犯血管匹配的患者（男/女，31/9；年龄 69±9 岁）进行比较。分析斑块特征，包括血管重构、斑块一致性，包括代表富含脂质病变的低衰减斑块和高衰减斑块的钙沉积模式。
SF 组（25/40，63%）中斑块周长的钙沉积（即环形钙化）显著多于无 SF 组（2/40，5.0%）（p<0.001）。在计算冠状动脉钙积分时，非增强 CT 上的 CTA 也证实了 CPC 的存在位于同一位置。SF 组的正性重构指数显著较高（1.5[1.3 至 1.8]比 1.2[1.0 至 1.5]；p<0.001），斑块密度显著较低（23.5[9.5 至 40]HU 比 45[29 至 86]HU；p=0.001）。条件逻辑回归分析显示，CPC、斑块密度和血脂异常是 SF 的预测因素，其中 CPC 最强（比值比：79；95%置信区间：8 至 783，p<0.0001）。
CTA 证实的 CPC 伴低衰减斑块和正性重构是 PCI 过程中 SF 的决定因素。如果在接受 PCI 的患者中获得 CTA 结果，介入医生应该注意 SF 的发生可能性。
