Souza Cristiano F, Doi Hiroshi, Mintz Gary S, Lansky Alexandra J, Witzenbichler Bernhard, Guagliumi Giulio, Brodie Bruce R, Kellett Mirle A, Xu Ke, Mehran Roxana, Stone Gregg W, Maehara Akiko
aClinical Trials Center, Cardiovascular Research Foundation bDivision of Cardiology, Columbia University Medical Center cZena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York dYale Cardiovascular Clinical Research Program, Yale University School of Medicine, New Haven, Connecticut eLeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, North Carolina fMaine Medical Center, Portland, Maine, USA gHelios Amper-Klinikum, Dachau, Germany hOspedale Papa Giovanni XXIII, Bergamo, Italy.
Coron Artery Dis. 2015 Sep;26(6):469-75. doi: 10.1097/MCA.0000000000000251.
Plaque ruptures and attenuated plaques are considered to be unstable and have been identified in both culprit and nonculprit lesions of patients with ST-segment elevation myocardial infarction (STEMI). However, there are limited data available on the natural evolution of these plaques and their long-term clinical outcome. We investigated the natural evolution and long-term impact of plaque ruptures and attenuated plaques in untreated segments of infarct-related arteries in patients with STEMI.
In the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction trial, 389 patients with 429 lesions underwent intravascular ultrasound (IVUS) at baseline. Follow-up IVUS at 13 months was conducted in 245 patients. Three-year follow-up data were available for all patients.
Segments not treated between baseline and follow-up were compared. Baseline IVUS identified 29 plaque ruptures in 27 patients (7%). Of 11 plaque ruptures with follow-up IVUS, four healed and seven persisted. Conversely, through follow-up IVUS, nine new plaque ruptures in nine patients (4%) were identified. Attenuated plaques were identified in 31 of 38 plaque ruptures (81.5%), of which 24 were in the same circumferential segment as the ruptured cavity and seven were within 5 mm proximal or distal to the plaque rupture. Morphologic changes during follow-up, including new plaque ruptures and changes in the attenuated plaque frequency and distribution, were not accompanied by either serious lumen compromise or clinical events.
Serial IVUS analysis demonstrated that the morphology of unstable plaques within untreated segments in STEMI patients treated with optimal systemic therapies markedly changed during the 13-month follow-up period, without lumen compromise or clinical events at the 3-year follow-up.
斑块破裂和变薄的斑块被认为是不稳定的，并且已在ST段抬高型心肌梗死（STEMI）患者的罪犯病变和非罪犯病变中均被识别出。然而，关于这些斑块的自然演变及其长期临床结局的数据有限。我们研究了STEMI患者梗死相关动脉未治疗节段中斑块破裂和变薄斑块的自然演变及其长期影响。
在急性心肌梗死血管重建和支架置入术疗效协调试验中，389例患者的429处病变在基线时接受了血管内超声（IVUS）检查。245例患者在13个月时进行了随访IVUS检查。所有患者均有3年随访数据。
比较了基线和随访期间未治疗的节段。基线IVUS在27例患者（7%）中识别出29处斑块破裂。在11处有随访IVUS检查的斑块破裂中，4处愈合，7处持续存在。相反，通过随访IVUS，在9例患者（4%）中识别出9处新的斑块破裂。在38处斑块破裂中的31处（81.5%）识别出变薄斑块，其中24处在与破裂腔相同的圆周节段，7处在斑块破裂近端或远端5毫米范围内。随访期间的形态学变化，包括新的斑块破裂以及变薄斑块频率和分布的变化，均未伴有严重的管腔狭窄或临床事件。
系列IVUS分析表明，在接受最佳系统治疗的STEMI患者中，未治疗节段内不稳定斑块的形态在13个月的随访期内发生了显著变化，在3年随访时未出现管腔狭窄或临床事件。
