冠状动脉疾病患者他汀类药物治疗缺乏有利血管反应的临床预测因素：一项连续光学相干断层扫描研究。

Clinical Predictors for Lack of Favorable Vascular Response to Statin Therapy in Patients With Coronary Artery Disease: A Serial Optical Coherence Tomography Study.

机构信息

Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA.

出版信息

J Am Heart Assoc. 2017 Nov 1;6(11):e006241. doi: 10.1161/JAHA.117.006241.

BACKGROUND

Previous studies have demonstrated that statin therapy improves cardiac outcomes, probably by stabilizing thin-cap fibroatheroma in patients with coronary artery disease. However, major adverse cardiac events still occur in some patients, despite statin therapy. The aim of this study is to identify clinical predictors for the lack of a favorable vascular response to statin therapy in patients with coronary artery disease.

METHODS AND RESULTS

A total of 140 nonculprit plaques from 84 patients with coronary artery disease who were treated with a statin and had serial optical coherence tomography imaging (median interval, 6.3 months) were included. Thin-cap area (fibrous cap thickness, <200 μm) was measured using a novel 3-dimensional computer-aided algorithm. Overall, the thin-cap area significantly decreased from baseline (median, 2.852 mm; 25-75 percentile, 1.023-6.157 mm) to follow-up (median, 1.210 mm; 25-75 percentile, 0.250-3.192 mm; <0.001), and low-density lipoprotein cholesterol significantly decreased from baseline (mean±SD, 92.9±30.1 mg/dL) to follow-up (mean±SD, 76.3±23.3 mg/dL; <0.001). The general linear model with multiple predictor variables revealed that the thin-cap area was significantly higher in patients with chronic kidney disease than in those without it (regression coefficient b, 1.691 mm; 95% confidence interval, 0.350-3.033 mm; =0.013) and lower in patients with acute coronary syndrome (regression coefficient b, -1.535 mm; 95% confidence interval, -2.561 to -0.509 mm; =0.003).

CONCLUSIONS

Chronic kidney disease is an independent predictor for the lack of a favorable vascular response to statin therapy, whereas acute coronary syndrome is an independent predictor for favorable vascular response to statin therapy. These findings should be further warranted in future prospective studies.

CLINICAL TRIAL REGISTRATION

URL: http://www.clinicaltrials.gov. Unique identifier: NCT01110538.

背景

先前的研究表明，他汀类药物治疗可改善心脏预后，可能通过稳定冠状动脉疾病患者的薄帽纤维粥样斑块来实现。然而，尽管进行了他汀类药物治疗，一些患者仍会发生主要不良心脏事件。本研究旨在确定冠状动脉疾病患者他汀类药物治疗缺乏有利血管反应的临床预测因素。

方法和结果

共纳入 84 例冠状动脉疾病患者的 140 个非罪犯斑块，这些患者接受了他汀类药物治疗并进行了连续光学相干断层扫描成像（中位数间隔 6.3 个月）。使用一种新的三维计算机辅助算法测量薄帽面积（纤维帽厚度＜200μm）。总体而言，从基线（中位数 2.852mm；25%-75%分位数 1.023-6.157mm）到随访（中位数 1.210mm；25%-75%分位数 0.250-3.192mm；<0.001），薄帽面积显著减小，低密度脂蛋白胆固醇从基线（平均值±标准差 92.9±30.1mg/dL）降至随访时（平均值±标准差 76.3±23.3mg/dL；<0.001）。多变量预测变量的一般线性模型显示，慢性肾脏病患者的薄帽面积明显高于无慢性肾脏病患者（回归系数 b 1.691mm；95%置信区间 0.350-3.033mm；=0.013），而急性冠状动脉综合征患者的薄帽面积明显低于无急性冠状动脉综合征患者（回归系数 b -1.535mm；95%置信区间 -2.561 至 -0.509mm；=0.003）。