Columbia University Medical Center, New York, New York, USA.
JACC Cardiovasc Imaging. 2013 Aug;6(8):908-16. doi: 10.1016/j.jcmg.2013.04.008. Epub 2013 Jul 10.
The purpose of this study was to determine the clinical impact of non-fibroatheroma lesion phenotype in patients presenting with an acute coronary syndrome (ACS).
Although fibroatheromas (FAs) are known to be clinically unstable, the impact of non-FA lesion phenotype on clinical outcomes has not been studied.
In the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study, patients presenting with an ACS underwent 3-vessel grayscale and virtual histology intravascular ultrasound (VH-IVUS) after successful percutaneous intervention for all culprit lesions and were followed for 3 years. Patients were divided into those who had only the non-FA phenotype (pathological intimal thickening or fibrotic and/or fibrocalcific lesions) versus those who had at least 1 nonculprit FA.
Among 2,880 nonculprit lesions identified by VH-IVUS, 39.8% were non-FAs (1,042 pathological intimal thickening, 72 fibrotic, and 33 fibrocalcific). Nonculprit major adverse cardiac events (MACE) (death, myocardial infarction, or urgent rehospitalization for progressive or unstable angina) were attributed to only 7 non-FA lesions (0.7%) versus 43 FA lesions (2.7%, p < 0.001) during 3 years follow-up. Of 609 patients, 67 (11.0%) patients had only non-FA lesion phenotypes. Patients with only non-FAs tended to be younger and more often female, have fewer nonculprit lesions and less overall plaque burden and necrotic core, and fewer nonculprit lesion MACE compared with patients with at least 1 FA. In the adjusted Cox proportional hazards model, absence of a FA was a significant predictive of a lower 3-year nonculprit MACE rate (hazard ratio: 0.23; 95% confidence interval: 0.06 to 0.95).
Non-FA lesions were clinically stable and were rarely associated with clinical events during 3 years of follow-up. The intermediate-term prognosis in patients presenting with ACS in whom all nonculprit lesions are non-FAs is favorable. (
An Imaging Study in Patients With Unstable Atherosclerotic Lesions; NCT00180466).
本研究旨在确定急性冠脉综合征（ACS）患者中非纤维粥样瘤病变表型的临床影响。
虽然纤维粥样瘤（FA）已知具有临床不稳定性，但非 FA 病变表型对临床结果的影响尚未得到研究。
在 PROSPECT（提供对冠状动脉树中事件预测因子的区域观察）研究中，对所有罪犯病变成功进行经皮介入治疗后，ACS 患者接受了 3 支血管灰度和虚拟组织学血管内超声（VH-IVUS）检查，并进行了 3 年随访。患者分为仅存在非 FA 表型（病理性内膜增厚或纤维性和/或纤维钙化病变）与至少存在 1 个非罪犯 FA 的患者。
在 VH-IVUS 识别的 2880 个非罪犯病变中，39.8%是非 FA（1042 个病理性内膜增厚，72 个纤维性，33 个纤维钙化）。非罪犯主要不良心脏事件（MACE）（死亡、心肌梗死或因进行性或不稳定型心绞痛再次紧急住院）归因于仅 7 个非 FA 病变（0.7%）与 43 个 FA 病变（2.7%），在 3 年随访期间。在 609 例患者中，67 例（11.0%）患者仅有非 FA 病变表型。与至少存在 1 个 FA 的患者相比，仅存在非 FA 的患者更年轻，更常为女性，非罪犯病变和总斑块负荷以及坏死核心更少，非罪犯病变 MACE 也更少。在调整后的 Cox 比例风险模型中，不存在 FA 是 3 年非罪犯 MACE 发生率较低的显著预测因素（风险比：0.23；95%置信区间：0.06 至 0.95）。
非 FA 病变具有临床稳定性，在 3 年随访期间很少与临床事件相关。ACS 患者中所有非罪犯病变均为非 FA 时，其中期预后良好。（PROSPECT：不稳定粥样硬化病变患者的影像学研究；NCT00180466）。
