Zhan Yefei, Zhang Yingying, Hou Jingbo, Lin Guochang, Yu Bo
Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, and the Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China; Department of Intensive Care Unit, Ningbo No 2 Hospital, Ningbo, China.
Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, and the Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
Can J Cardiol. 2017 Aug;33(8):991-997. doi: 10.1016/j.cjca.2017.05.003. Epub 2017 May 10.
There are several forms of calcium deposition, which play different roles in the stability of the coronary artery. It remains unknown whether certain calcification morphological characteristics determine rupture of lipid-rich lesions in the same plaque in acute coronary syndrome (ACS).
We retrospectively analyzed 550 patients with ACS between May 2008 and October 2014, who had undergone preintervention optical coherence tomography (OCT) imaging examination. A total of 78 patients with 78 culprit lipid-rich lesions having superficial calcifications on OCT images were included in this study, among which 45 were ruptured lesions with calcium and 33 were nonruptured lipid-rich lesion with calcium. The smallest depth of calcium (CAL-DEP) was determined, and the morphology of the calcifications and plaques was analyzed during preintervention OCT imaging.
The CAL-DEP was significantly thinner in ruptured lesions with calcium than in nonruptured lipid-rich lesion with calcium (median, 50 [interquartile range (IQR), 33-63] μm vs 110 [73-208] μm; P < 0.001) and in myocardial infarction than in unstable angina pectoris patients (median, 57 [IQR, 36-78] μm vs median, 85 [IQR, 43-140] μm; P = 0.045). For lipid-rich calcified plaques, when CAL-DEP was < 63 μm, the lipid-rich lesion was most vulnerable and prone to rupture (sensitivity = 77.8%; specificity = 81.8%; area under the curve: 0.804; P < 0.0001).
Small CAL-DEP in lipid-rich calcified plaques is a morphological characteristic of a vulnerable plaque phenotype. A CAL-DEP ≤ 63 μm is the critical depth of calcification for lipid-rich calcified plaque rupture in patients with ACS.
钙沉积有多种形式，其在冠状动脉稳定性中发挥着不同作用。急性冠状动脉综合征（ACS）中，特定的钙化形态特征是否决定同一斑块中富含脂质病变的破裂尚不清楚。
我们回顾性分析了2008年5月至2014年10月期间接受干预前光学相干断层扫描（OCT）成像检查的550例ACS患者。本研究纳入了78例在OCT图像上有浅表钙化的罪犯富含脂质病变患者，其中45例为有钙化的破裂病变，33例为有钙化的未破裂富含脂质病变。确定了钙化的最小深度（CAL-DEP），并在干预前OCT成像期间分析了钙化和斑块的形态。
有钙化的破裂病变的CAL-DEP显著薄于有钙化的未破裂富含脂质病变（中位数，50[四分位间距（IQR），33 - 63]μm对110[73 - 208]μm；P < 0.001），心肌梗死患者的CAL-DEP也显著薄于不稳定型心绞痛患者（中位数，57[IQR，36 - 78]μm对中位数，85[IQR，43 - 140]μm；P = 0.045）。对于富含脂质的钙化斑块，当CAL-DEP < 63μm时，富含脂质的病变最易破裂（敏感性 = 77.8%；特异性 = 81.8%；曲线下面积：0.804；P < 0.0001）。
富含脂质的钙化斑块中较小的CAL-DEP是易损斑块表型的形态学特征。CAL-DEP≤63μm是ACS患者富含脂质的钙化斑块破裂的关键钙化深度。
