Sugiyama Tomoyo, Kimura Shigeki, Akiyama Daiki, Hishikari Keiichi, Kawaguchi Naohiko, Kamiishi Tetsuo, Hikita Hiroyuki, Takahashi Atsushi, Isobe Mitsuaki
Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan; Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
Int J Cardiol. 2014 Sep;176(1):182-90. doi: 10.1016/j.ijcard.2014.07.005. Epub 2014 Jul 11.
Tissue prolapse (TP) is sometimes observed after percutaneous coronary intervention (PCI), but its clinical significance remains unclear. We investigated the relationship between TP volume on optical coherence tomography (OCT) after PCI and underlying plaque morphologies and the impact of TP on clinical outcomes.
We investigated 178 native coronary lesions with normal pre-PCI creatine kinase-myocardial band (CK-MB) values (154 lesions with stable angina; 24 with unstable angina). TP was defined as tissue extrusion from stent struts throughout the stented segments. All lesions were divided into tertiles according to TP volume. The differences in plaque morphologies and 9-month clinical outcomes were evaluated.
TP volume was correlated with lipid arc (r=0.374, p<0.0001) and fibrous cap thickness (r=-0.254, p=0.001) at the culprit sites. The frequency of thin-cap fibroatheroma (TCFA) was higher in the largest TP tertile (≥ 1.38 mm(3)) (p=0.015). In multivariate analysis, right coronary artery lesion (odds ratio [OR]: 2.779; p=0.005), lesion length (OR: 1.047; p=0.003), and TCFA (OR: 2.430; p=0.022) were related to the largest TP tertile. Lesions with post-PCI CK-MB elevation (>upper reference limit) had larger TP volume than those without (1.28 [0.48 to 3.97] vs. 0.70 [0.16 to 1.64] mm(3), p=0.007). The prevalence of cardiac events during the 9-month follow-up was not significantly different according to TP volume.
TP volume on OCT was related to plaque morphologies and instability, and post-PCI myocardial injury, but not to worse 9-month outcomes.
经皮冠状动脉介入治疗（PCI）后有时会观察到组织脱垂（TP），但其临床意义仍不明确。我们研究了PCI后光学相干断层扫描（OCT）上TP体积与潜在斑块形态之间的关系以及TP对临床结局的影响。
我们调查了178例PCI前肌酸激酶心肌带（CK-MB）值正常的原发性冠状动脉病变（154例稳定型心绞痛病变；24例不稳定型心绞痛病变）。TP定义为整个支架段从支架支柱挤出的组织。所有病变根据TP体积分为三分位数。评估斑块形态和9个月临床结局的差异。
罪犯部位的TP体积与脂质弧（r = 0.374，p < 0.0001）和纤维帽厚度（r = -0.254，p = 0.001）相关。在最大TP三分位数（≥1.38 mm³）中，薄帽纤维粥样瘤（TCFA）的频率更高（p = 0.015）。在多变量分析中，右冠状动脉病变（优势比[OR]：2.779；p = 0.005）、病变长度（OR：1.047；p = 0.003）和TCFA（OR：2.430；p = 0.022）与最大TP三分位数相关。PCI后CK-MB升高（>参考上限）的病变TP体积大于未升高的病变（1.28 [0.48至3.97] vs. 0.70 [0.16至1.64] mm³，p = 0.007）。根据TP体积，9个月随访期间心脏事件的发生率无显著差异。
OCT上的TP体积与斑块形态和不稳定性以及PCI后心肌损伤有关，但与9个月时更差的结局无关。
