Tsujita Kenichi, Yamanaga Kenshi, Komura Naohiro, Sakamoto Kenji, Miyazaki Takashi, Oimatsu Yu, Ishii Masanobu, Tabata Noriaki, Akasaka Tomonori, Sueta Daisuke, Yamamoto Eiichiro, Yamamuro Megumi, Izumiya Yasuhiro, Kojima Sunao, Nakamura Sunao, Kaikita Koichi, Hokimoto Seiji, Ogawa Hisao
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Int J Cardiol. 2016 Oct 1;220:112-5. doi: 10.1016/j.ijcard.2016.06.191. Epub 2016 Jun 25.
Although acute coronary syndrome (ACS) mainly arises from plaque ruptures (PR), precise mechanisms underlying ACS without PR are unknown. We sought to examine clinical, angiographic and intravascular ultrasound (IVUS) characteristics of ACS without PR.
Culprit lesions of 161 ACS patients were categorized by the presence or absence of PR (PR group: n=57, Non-PR group: n=104). Lower abdominal circumference (86±10cm vs 90±9cm, p=0.02), lower prevalence of myocardial infarction (53% vs 82%, p=0.0002), and higher prevalence of definite vasospasm (15% vs 2%, p=0.006) were found in Non-PR group. Morphologically, Non-PR group was associated with simpler Ambrose classification (36% vs 14%, p=0.004), less hypoechoic plaque (45% vs 65%, p=0.04) and lower incidence of IVUS-detected thrombus (21% vs 54%, p<0.0001), compared with PR group. On quantitative IVUS, although minimum lumen area (MLA) was similar between the groups, vessel (14.2±5.4mm(2) vs 17.5±5.1mm(2), p=0.0002) and plaque (11.6±5.0mm(2) vs 14.9±4.9mm(2), p<0.0001) areas were significantly smaller at MLA site in Non-PR group than in PR group. On multivariate analysis, average plaque area was only an independent IVUS-predictor of non-rupture ACS (odds ratio: 0.85, p=0.01).
Compared to ACS with PR, non-rupture ACS arise from more hyperechoic (allegedly "stable") plaque with smaller vessel and plaque area, leading to lower incidence of thrombotic occlusion. Coronary vasospasm might be a possible pathogenic mechanism underlying non-rupture ACS.
尽管急性冠状动脉综合征（ACS）主要由斑块破裂（PR）引起，但无斑块破裂的ACS的确切机制尚不清楚。我们试图研究无斑块破裂的ACS的临床、血管造影和血管内超声（IVUS）特征。
161例ACS患者的罪犯病变根据有无斑块破裂进行分类（斑块破裂组：n = 57，无斑块破裂组：n = 104）。无斑块破裂组患者的腹围较低（86±10cm vs 90±9cm，p = 0.02），心肌梗死患病率较低（53% vs 82%，p = 0.0002），明确血管痉挛的患病率较高（15% vs 2%，p = 0.006）。形态学上，与斑块破裂组相比，无斑块破裂组的安布罗斯分类更简单（36% vs 14%，p = 0.004），低回声斑块较少（45% vs 65%，p = 0.04），IVUS检测到的血栓发生率较低（21% vs 54%，p < 0.0001）。在定量IVUS上，尽管两组之间的最小管腔面积（MLA）相似，但无斑块破裂组MLA部位的血管面积（14.2±5.4mm² vs 17.5±5.1mm²，p = 0.0002）和斑块面积（11.6±5.0mm² vs 14.9±4.9mm²，p < 0.0001）明显小于斑块破裂组。多因素分析显示，平均斑块面积是无破裂ACS的唯一独立IVUS预测因子（比值比：0.85，p = 0.01）。
与有斑块破裂的ACS相比，无破裂ACS源于回声更强（据称“稳定”）的斑块，血管和斑块面积较小，导致血栓闭塞的发生率较低。冠状动脉痉挛可能是无破裂ACS的一种潜在致病机制。
