Institute for Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
EuroIntervention. 2014 Nov;10(7):815-23. doi: 10.4244/EIJV10I7A141.
New markers to help stratify coronary atherosclerosis are needed. Although attempts have been made to differentiate active lesions from those that are stable, none of these has ever been formalised into a discriminatory score. The aim of this study was to analyse the differences between culprit ACS lesions and culprit stable angina lesions with intravascular ultrasound-derived virtual histology and to construct and validate a plaque score.
Prior to percutaneous coronary intervention (PCI), we performed volumetric, intravascular ultrasound-derived virtual histology (IVUS-VH) analysis in acute coronary syndrome (ACS) culprit lesions (AC - n=70) and stable angina culprit lesions (SC - n=35). A direct statistical comparison of IVUS-VH data and multiple logistic regression analysis was undertaken. Four main factors were found to be associated (p<0.05) with an AC lesion phenotype: necrotic core/dense calcium (NC/DC) ratio; minimum lumen area <4 mm2 (MLA <4); remodelling index @MLA >1.05 and VH-TCFA presence. Calculation of each logistic regression coefficient and the equation produces an active plaque discrimination score with an AUC of 0.96 on receiver operating characteristics (ROC) analysis. Validation of the score in 50 independent plaques from the Thoraxcenter in Rotterdam revealed an AUC of 0.71, confirming continued diagnostic ability.
We have found four features on IVUS and VH that can predict and discriminate ACS culprit lesion phenotypes from those that are clinically stable. Subsequently, we have constructed and validated the Liverpool Active Plaque Score based upon these features. It is hoped this score may help diagnose active coronary plaques, in the future, to help prevent major adverse cardiac events.
需要新的标志物来分层冠状动脉粥样硬化。尽管已经尝试区分活动性病变与稳定性病变，但这些标志物都没有被正式确定为一种鉴别评分。本研究旨在分析血管内超声衍生虚拟组织学（IVUS-VH）检测到的急性冠脉综合征（ACS）罪犯病变与稳定型心绞痛罪犯病变之间的差异，并构建和验证斑块评分。
在经皮冠状动脉介入治疗（PCI）之前，我们对急性冠脉综合征（ACS）罪犯病变（AC- n=70）和稳定型心绞痛罪犯病变（SC- n=35）进行了容积式血管内超声衍生虚拟组织学（IVUS-VH）分析。对 IVUS-VH 数据进行直接统计学比较和多因素逻辑回归分析。发现四个主要因素与 AC 病变表型相关（p<0.05）：坏死核心/致密钙（NC/DC）比值；最小管腔面积<4mm2（MLA<4）；重塑指数@MLA>1.05 和 VH-TCFA 存在。计算每个逻辑回归系数和方程得出一个活性斑块鉴别评分，在接收者操作特征（ROC）分析中 AUC 为 0.96。在鹿特丹胸科中心的 50 个独立斑块中对该评分进行验证，AUC 为 0.71，证实了其持续的诊断能力。
我们在 IVUS 和 VH 上发现了四个特征，这些特征可以预测和区分 ACS 罪犯病变表型与临床上稳定的病变表型。随后，我们根据这些特征构建并验证了利物浦活性斑块评分。希望这个评分将来能够帮助诊断活性冠状动脉斑块，以预防主要不良心脏事件。
