Danek Barbara Anna, Karatasakis Aris, Karacsonyi Judit, Alame Aya, Resendes Erica, Kalsaria Pratik, Nguyen-Trong Phuong-Khanh J, Rangan Bavana V, Roesle Michele, Abdullah Shuaib, Banerjee Subhash, Brilakis Emmanouil S
VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX.
VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX; Minneapolis Heart Institute, Minneapolis, MN.
Cardiovasc Revasc Med. 2017 Apr-May;18(3):177-181. doi: 10.1016/j.carrev.2016.12.006. Epub 2016 Dec 15.
Coronary lipid core plaque may be associated with the incidence of subsequent cardiovascular events.
We analyzed outcomes of 239 patients who underwent near-infrared spectroscopy (NIRS) coronary imaging between 2009-2011. Multivariable Cox regression was used to identify variables independently associated with the incidence of major adverse cardiovascular events (MACE; cardiac mortality, acute coronary syndromes (ACS), stroke, and unplanned revascularization) during follow-up.
Mean patient age was 64±9years, 99% were men, and 50% were diabetic, presenting with stable coronary artery disease (61%) or an acute coronary syndrome (ACS, 39%). Target vessel pre-stenting median lipid core burden index (LCBI) was 88 [interquartile range, IQR 50-130]. Median LCBI in non-target vessels was 57 [IQR 26-94]. Median follow-up was 5.3years. The 5-year MACE rate was 37.5% (cardiac mortality was 15.0%). On multivariable analysis the following variables were associated with MACE: diabetes mellitus, prior percutaneous coronary intervention performed at index angiography, and non-target vessel LCBI. Non-target vessel LCBI of 77 was determined using receiver-operating characteristic curve analysis to be a threshold for prediction of MACE in our cohort. The adjusted hazard ratio (HR) for non-target vessel LCBI ≥77 was 14.05 (95% confidence interval (CI) 2.47-133.51, p=0.002). The 5-year cumulative incidence of events in the above-threshold group was 58.0% vs. 13.1% in the below-threshold group.
During long-term follow-up of patients who underwent NIRS imaging, high LCBI in a non-PCI target vessel was associated with increased incidence of MACE.
冠状动脉脂质核心斑块可能与随后心血管事件的发生率相关。
我们分析了2009年至2011年间接受近红外光谱（NIRS）冠状动脉成像的239例患者的结局。采用多变量Cox回归来确定与随访期间主要不良心血管事件（MACE；心脏死亡、急性冠状动脉综合征（ACS）、中风和非计划血管重建）发生率独立相关的变量。
患者平均年龄为64±9岁，99%为男性，50%为糖尿病患者，表现为稳定型冠状动脉疾病（61%）或急性冠状动脉综合征（ACS，39%）。靶血管支架置入术前脂质核心负荷指数（LCBI）中位数为88[四分位间距，IQR 50 - 130]。非靶血管的LCBI中位数为57[IQR 26 - 94]。中位随访时间为5.3年。5年MACE发生率为37.5%（心脏死亡率为15.0%）。多变量分析显示，以下变量与MACE相关：糖尿病、在索引血管造影时既往进行过经皮冠状动脉介入治疗以及非靶血管LCBI。通过受试者工作特征曲线分析确定，非靶血管LCBI为77是我们队列中预测MACE的阈值。非靶血管LCBI≥77的调整后风险比（HR）为14.05（95%置信区间（CI）2.47 - 133.51，p = 0.002）。阈值以上组的5年累积事件发生率为58.0%，而阈值以下组为13.1%。
在接受NIRS成像患者的长期随访中，非PCI靶血管的高LCBI与MACE发生率增加相关。
