Vergallo Rocco, Uemura Shiro, Soeda Tsunenari, Minami Yoshiyasu, Cho Jin-Man, Ong Daniel S, Aguirre Aaron D, Gao Lei, Biasucci Luigi M, Crea Filippo, Yu Bo, Lee Hang, Kim Chong-Jin, Jang Ik-Kyung
From the Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (R.V., T.S., Y.M., D.S.O., L.G., I.-K.J.); Cardiology Division, Catholic University of the Sacred Heart, Rome, Italy (R.V., L.M.B., F.C.); Nara Medical University, Japan (S.U.); Division of Cardiology, Kyung Hee University, Seoul, South Korea (J.-M.C., C.-J.K., I.-K.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.D.A.); The 2nd Affiliated Hospital of Harbin Medical University, China (B.Y.); and Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston (H.L.).
Arterioscler Thromb Vasc Biol. 2016 Nov;36(11):2229-2238. doi: 10.1161/ATVBAHA.116.307891. Epub 2016 Sep 15.
Plaque rupture may be the local expression of a widespread coronary instability. This study aimed to investigate: (1) the prevalence and characteristics of nonculprit plaque rupture; (2) the pancoronary atherosclerotic phenotype in patients with and without nonculprit plaque rupture; and (3) the prevalence and predictors of multiple plaque ruptures.
Six hundred and seventy-five nonculprit plaques from 261 patients (34 acute myocardial infarction, 73 unstable angina pectoris, and 154 stable angina pectoris) were analyzed by 3-vessel optical coherence tomography. Nonculprit plaque ruptures were identified in 51 patients (20%). Patients with nonculprit plaque ruptures had higher prevalence of thin-cap fibroatheroma (51% versus 13%; P<0.001) in the 3 major epicardial coronary vessels. Multiple plaque ruptures were observed in 20% of patients (38% acute myocardial infarction versus 10% unstable angina pectoris versus 19% stable angina pectoris; P=0.042). Thin-cap fibroatheroma, intimal vasculature, and macrophages were independent morphological predictors of multiple plaque ruptures, whereas acute myocardial infarction and chronic kidney disease were independent clinical predictors. Patients with nonculprit plaque ruptures showed higher 1-year rates of nontarget lesion revascularization (11.8% versus 4.4%; P=0.039).
Nonculprit plaque ruptures were observed in 20% of patients with coronary artery disease and were associated with pancoronary vulnerability and higher 1-year revascularization rate.
斑块破裂可能是广泛冠状动脉不稳定的局部表现。本研究旨在调查：（1）非罪犯斑块破裂的发生率和特征；（2）有无非罪犯斑块破裂患者的全冠状动脉粥样硬化表型；（3）多处斑块破裂的发生率和预测因素。
通过三支血管光学相干断层扫描分析了261例患者（34例急性心肌梗死、73例不稳定型心绞痛和154例稳定型心绞痛）的675个非罪犯斑块。51例患者（20%）发现有非罪犯斑块破裂。非罪犯斑块破裂患者在三支主要心外膜冠状动脉中薄帽纤维粥样斑块的发生率更高（51%对13%；P<0.001）。20%的患者观察到多处斑块破裂（急性心肌梗死患者为38%，不稳定型心绞痛患者为10%，稳定型心绞痛患者为19%；P=0.042）。薄帽纤维粥样斑块、内膜血管系统和巨噬细胞是多处斑块破裂的独立形态学预测因素，而急性心肌梗死和慢性肾脏病是独立的临床预测因素。非罪犯斑块破裂患者的非靶病变血运重建1年发生率更高（11.8%对4.4%；P=0.039）。
在20%的冠心病患者中观察到非罪犯斑块破裂，其与全冠状动脉易损性及更高的1年血运重建率相关。
