急性冠状动脉综合征年轻与老年患者的罪犯斑块特征：来自FORMIDABLE注册研究的光学相干断层扫描研究
Culprit plaque characteristics in younger versus older patients with acute coronary syndromes: An optical coherence tomography study from the FORMIDABLE registry.
作者信息
Barbero Umberto, Scacciatella Paolo, Iannaccone Mario, D'Ascenzo Fabrizio, Niccoli Giampaolo, Colombo Francesco, Ugo Fabrizio, Colangelo Salvatore, Mancone Massimo, Calcagno Simone, Sardella Gennaro, Amabile Nicolas, Motreff Pascal, Toutouzas Konstantinos, Garbo Roberto, Tamburino Corrado, Montefusco Antonio, Omedè Pierluigi, Moretti Claudio, D'amico Maurizio, Souteyrand Geraud, Gaita Fiorenzo, Templin Christian
机构信息
Department of Cardiology, University of Turin, Città della Scienza e della Salute Hospital, Turin, Italy.
Department of Cardiology, S.G. Bosco Hospital, Turin, Italy.
出版信息
Catheter Cardiovasc Interv. 2018 Jul;92(1):E1-E8. doi: 10.1002/ccd.27172. Epub 2017 Jul 12.
OBJECTIVES
Culprit plaque characteristics in young patients who experience an Acute Coronary Syndrome (ACS) evaluated by OCT (Optical Coherence Tomography) have to be defined. The OCT-FORMIDABLE is a multicentre retrospective registry enrolling consecutive patients with ACS who performed OCT in 9 European centres.
METHODS
Patients were divided in two groups according to age at presentation: juvenile-ACS (age ≤ 50 years) and not juvenile-ACS (age > 50 years). Primary end-point was the prevalence of plaque rupture (PR). Secondary end point was the prevalence of thin cap fibro atheroma (TCFA), fibrocalcific and fibrotic plaque.
RESULTS
285 patients were included, 71 (24.9%) in juvenile-ACS group and 215 (75.1%) in not juvenile-ACS group. Younger patients showed a trend for a higher prevalence of TCFA (70 vs. 58%, P = 0.06) and thrombus presence (62 vs. 51%, P = 0.1), while no statistical difference concerning PR (70 vs. 64%, P = 0.29). Of interest patients younger that 35 years showed a higher prevalence of PR compared to patients aged between 35 and 45 or 45 and 50 years (100 vs. 72 vs. 55%, P = 0.03). Culprit plaque in juvenile-ACS group showed more frequently a reduced mean cap thickness (119 ± 66 vs. 155 ± 95 nm, P = 0.05) and less frequently fibrotic (32 vs. 57%, P < 0.001) or fibrocalcific (17 vs. 36%, P = 0.003) characteristics.
CONCLUSION
young patients with ACS show a trend for a higher prevalence of culprit PR, a thinner cap and less fibrotic or fibrocalcific components.
目的
明确通过光学相干断层扫描（OCT）评估的急性冠状动脉综合征（ACS）年轻患者的罪犯斑块特征。OCT - FORMIDABLE是一项多中心回顾性注册研究，纳入了在9个欧洲中心接受OCT检查的连续ACS患者。
方法
根据就诊时年龄将患者分为两组：青少年ACS（年龄≤50岁）和非青少年ACS（年龄>50岁）。主要终点是斑块破裂（PR）的发生率。次要终点是薄帽纤维粥样斑块（TCFA）、纤维钙化和纤维化斑块的发生率。
结果
共纳入285例患者，青少年ACS组71例（24.9%），非青少年ACS组215例（75.1%）。年轻患者的TCFA发生率（70%对58%，P = 0.06）和血栓存在率（62%对51%，P = 0.1）有升高趋势，而PR发生率无统计学差异（70%对64%，P = 0.29）。有趣的是，35岁以下患者的PR发生率高于35至45岁或45至50岁患者（100%对72%对55%，P = 0.03）。青少年ACS组的罪犯斑块平均帽厚度更常减小（119±66对155±95纳米，P = 0.05），纤维化（32%对57%，P<0.001）或纤维钙化（17%对36%，P = 0.003）特征较少见。
结论
ACS年轻患者的罪犯PR发生率有升高趋势，帽更薄，纤维化或纤维钙化成分更少。
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