Ogura Yuji, Tsujita Kenichi, Shimomura Hideki, Yamanaga Kenshi, Komura Naohiro, Miyazaki Takashi, Ishii Masanobu, Tabata Noriaki, Akasaka Tomonori, Arima Yuichiro, Sakamoto Kenji, Kojima Sunao, Nakamura Sunao, Kaikita Koichi, Hokimoto Seiji, Ogawa Hisao
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
Division of Cardiology, Fukuoka Tokushukai Medical Center, Kasuga, Japan.
Heart Vessels. 2016 Mar;31(3):341-50. doi: 10.1007/s00380-014-0616-2. Epub 2014 Dec 19.
Acute coronary syndrome (ACS) is one of the main causes of cardiovascular death. According to rapid aging of society, the peak age of ACS onset has grown older globally. Despite growing recognition of the necessity to build the ACS prevention strategy in the elderly, patients background and culprit lesion morphology of these elderly ACS patients have not been well studied. We sought to assess the clinical characteristics and intravascular ultrasound (IVUS) findings of the culprit lesions in elderly ACS patients. One-hundred and fifty-eight consecutive ACS patients whose culprit lesions imaged by pre-intervention IVUS were divided into two groups based on the age of onset: elderly [E] group (≥75 years, n = 65) and non-elderly [NE] group (<75 years, n = 93). As compared with NE group, hemoglobin (12.7 ± 2.0 g/dL vs. 13.7 ± 1.6 g/dL, p = 0.001), estimated glomerular filtration rate (62.5 ± 22.5 mL/min/1.73 m(2) vs. 75.5 ± 20.5 mL/min/1.73 m(2), p = 0.0001), and body mass index (22.9 ± 3.4 kg/m(2) vs. 24.5 ± 3.4 kg/m(2), p = 0.003) were significantly lower, and comorbid malignancy was more common (20.0 vs 6.5 %, p = 0.01) in E group. Although whole culprit segment was not positively remodeled (mean vessel area was 15.2 ± 5.6 mm(3)/mm vs. 16.2 ± 5.1 mm(3)/mm, p = 0.16) in E group, at maximum external elastic membrane site of the culprit lesion, lumen area was smaller (5.5 ± 3.2 mm(2) vs. 6.7 ± 3.5 mm(2), p = 0.04), and plaque burden tended to be more abundant (70 ± 13 vs. 66 ± 13 %, p = 0.08). Interestingly, echo attenuation arc of culprit attenuated plaque was significantly greater in E group than in NE group (157 ± 83° vs. 118 ± 60°, p = 0.01). In conclusion, extracardiac comorbidity was more common in elderly ACS patients, and their culprit coronary lesions were still rupture prone, and "vulnerable."
急性冠状动脉综合征（ACS）是心血管死亡的主要原因之一。随着社会的快速老龄化，全球范围内ACS发病的高峰年龄已经增大。尽管越来越认识到有必要为老年人制定ACS预防策略，但这些老年ACS患者的患者背景和罪犯病变形态尚未得到充分研究。我们试图评估老年ACS患者罪犯病变的临床特征和血管内超声（IVUS）表现。连续158例经干预前IVUS成像显示罪犯病变的ACS患者根据发病年龄分为两组：老年[E]组（≥75岁，n = 65）和非老年[NE]组（<75岁，n = 93）。与NE组相比，E组的血红蛋白（12.7±2.0 g/dL对13.7±1.6 g/dL，p = 0.001）、估算肾小球滤过率（62.5±22.5 mL/min/1.73 m²对75.5±20.5 mL/min/1.73 m²，p = 0.0001）和体重指数（22.9±3.4 kg/m²对24.5±3.4 kg/m²，p = 0.003）显著更低，合并恶性肿瘤更常见（20.0%对6.5%，p = 0.01）。虽然E组罪犯病变的整个节段没有正向重构（平均血管面积为15.2±5.6 mm³/mm对16.2±5.1 mm³/mm，p = 0.16），但在罪犯病变的最大外弹力膜部位，管腔面积更小（5.5±3.2 mm²对6.7±3.5 mm²，p = 0.04），斑块负荷倾向于更丰富（70±13对66±13%，p = 0.08）。有趣的是，E组罪犯易损斑块的回声衰减弧明显大于NE组（157±83°对118±60°，p = 0.01）。总之，心外合并症在老年ACS患者中更常见，他们的罪犯冠状动脉病变仍然易于破裂且“易损”。
