肥胖对冠状动脉粥样硬化及经皮冠状动脉介入治疗结局的影响：药物洗脱支架双重抗血小板治疗评估的灰阶与虚拟组织学血管内超声亚研究
Effect of obesity on coronary atherosclerosis and outcomes of percutaneous coronary intervention: grayscale and virtual histology intravascular ultrasound substudy of assessment of dual antiplatelet therapy with drug-eluting stents.
作者信息
Kang Soo-Jin, Mintz Gary S, Witzenbichler Bernhard, Metzger D Christopher, Rinaldi Michael J, Duffy Peter L, Weisz Giora, Stuckey Thomas D, Brodie Bruce R, Shimizu Takehisa, Xu Ke, Kirtane Ajay J, Stone Gregg W, Maehara Akiko
机构信息
From the Cardiovascular Research Foundation, New York, NY (S.-J.K., G.S.M., G.W., T.S., K.X., A.J.K., G.W.S., A.M.); Asan Medical Center, Seoul, Korea (S.-J.K.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Columbia University Medical Center, New York-Presbyterian Hospital, NY (G.W., T.S., A.J.K., G.W.S., A.M.); LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (T.D.S., B.R.B.).
出版信息
Circ Cardiovasc Interv. 2014 Dec 31;8(1). doi: 10.1161/CIRCINTERVENTIONS.114.001392. Print 2015 Jan.
BACKGROUND
Obesity is a cardiovascular risk factor, but the obesity paradox in patients undergoing percutaneous coronary intervention is poorly understood.
METHODS AND RESULTS
Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) was a prospective, multicenter study of patients undergoing drug-eluting stent implantation. Overall, 780 patients (916 culprit lesions) were evaluated by grayscale and virtual histology-intravascular ultrasound pre-percutaneous coronary intervention. Poststenting intravascular ultrasound was done in 780 patients (894 treated lesions). Patients were divided into body mass index (BMI) tertiles. The high-BMI group had more diabetes mellitus, hypertension, and hyperlipidemia and more frequent plaque ruptures compared with the low-BMI group. At the minimal lumen area site, the high-BMI group had a larger plaque area (11.7 [11.0-12.4] versus 9.8 [9.3-10.4] mm(2)) and a greater plaque burden (77.3% [76.1%-78.5%] versus 74.4% [73.1%-75.8%]) compared with the low-BMI group; however, a larger external elastic membrane area (14.6 [13.8-15.3] versus 12.7 [12.1-13.3] mm(2)) resulted in a similar minimal lumen area compared with the low-BMI group. Post stenting, the high-BMI group had a significantly larger stent area versus the lower-BMI group. At 1-year follow-up, the high-BMI group was associated with less clinically driven target lesion revascularization compared with the low-BMI group in both the overall and the propensity-matched cohorts.
CONCLUSIONS
A high BMI was associated with a greater plaque burden; however, a larger external elastic membrane preserved lumen dimensions and was associated with a larger stent area during intravascular ultrasound-guided stent implantation. Thus, despite more comorbidities, greater plaque burden, and more plaque rupture, a high BMI was not associated with worse outcomes after drug-eluting stent implantation.
CLINICAL TRIAL REGISTRATION URL
http://www.clinicaltrials.gov. Unique identifier: NCT00638794.
背景
肥胖是一种心血管危险因素，但经皮冠状动脉介入治疗患者中的肥胖悖论尚不清楚。
方法与结果
药物洗脱支架双重抗血小板治疗评估（ADAPT-DES）是一项对接受药物洗脱支架植入患者的前瞻性多中心研究。总体而言，780例患者（916处罪犯病变）在经皮冠状动脉介入治疗前通过灰阶和虚拟组织学血管内超声进行评估。780例患者（894处治疗病变）进行了支架植入后血管内超声检查。患者按体重指数（BMI）三分位数分组。与低BMI组相比，高BMI组糖尿病、高血压和高脂血症更多，斑块破裂更频繁。在最小管腔面积部位，与低BMI组相比，高BMI组斑块面积更大（11.7 [11.0 - 12.4] 对 9.8 [9.3 - 10.4] mm²），斑块负荷更高（77.3% [76.1% - 78.5%] 对 74.4% [73.1% - 75.8%]）；然而，更大的外弹力膜面积（14.6 [13.8 - 15.3] 对 12.7 [12.1 - 13.3] mm²）使得高BMI组与低BMI组的最小管腔面积相似。支架植入后，高BMI组的支架面积显著大于低BMI组。在1年随访时，总体队列和倾向匹配队列中，高BMI组与低BMI组相比，由临床驱动的靶病变血运重建较少。
结论
高BMI与更大的斑块负荷相关；然而，更大的外弹力膜可维持管腔尺寸，并在血管内超声引导下的支架植入过程中与更大的支架面积相关。因此，尽管合并症更多、斑块负荷更大且斑块破裂更多，但高BMI与药物洗脱支架植入后的不良结局无关。
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