Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China.
The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, 150086 Harbin, China.
Eur Heart J. 2018 Jun 7;39(22):2077-2085. doi: 10.1093/eurheartj/ehy101.
Plaque erosion is a significant substrate of acute coronary thrombosis. This study sought to determine in vivo predictors of plaque erosion in patients with ST-segment elevation myocardial infarction (STEMI).
A prospective series of 822 STEMI patients underwent pre-intervention optical coherence tomography. Using established diagnostic criteria, 209 had plaque erosion (25.4%) and 564 had plaque rupture (68.6%). Plaque erosion was more frequent in women <50 years when compared with those ≥50 years of age (P = 0.009). There was a similar, but less striking, trend in men (P = 0.011). Patients with plaque erosion were more frequently current smokers but had fewer other coronary risk factors (dyslipidaemia, hypertension, chronic kidney disease, and diabetes mellitus) than those with plaque rupture. There was a preponderance of plaque erosion in the left anterior descending artery (LAD; 61.2%), whereas plaque rupture was more equally distributed in both the LAD (47.0%) and right coronary artery (43.3%). Despite the similar spatial distribution of erosions and ruptures over the lengths of the coronary arteries, plaque erosion occurred more frequently near a bifurcation (P < 0.001). In the multivariable analysis, age <50 years, current smoking, absence of other coronary risk factors, lack of multi-vessel disease, reduced lesion severity, larger vessel size, and nearby bifurcation were significantly associated with plaque erosion. Nearby bifurcation and current smoking were especially notable in men, while age <50 years was most predictive in women.
Plaque erosion was a predictable clinical entity distinct from plaque rupture in STEMI patients, and gender-specific role of risk factors in plaque erosion should be considered.
斑块侵蚀是急性冠状动脉血栓形成的重要底物。本研究旨在确定 ST 段抬高型心肌梗死（STEMI）患者中斑块侵蚀的体内预测因子。
对 822 例 STEMI 患者进行了前瞻性系列研究，在进行介入治疗前进行了光学相干断层扫描。使用既定的诊断标准，209 例患者有斑块侵蚀（25.4%），564 例患者有斑块破裂（68.6%）。与年龄≥50 岁的患者相比，年龄<50 岁的女性患者中斑块侵蚀更为常见（P=0.009）。在男性中也存在类似但不太明显的趋势（P=0.011）。与斑块破裂患者相比，斑块侵蚀患者更常为当前吸烟者，但其他冠状动脉危险因素（血脂异常、高血压、慢性肾脏病和糖尿病）较少。左前降支（LAD）中斑块侵蚀更为常见（61.2%），而斑块破裂在 LAD（47.0%）和右冠状动脉（43.3%）中分布更为均匀。尽管斑块侵蚀和破裂在冠状动脉的长度上具有相似的空间分布，但在分叉处更常发生斑块侵蚀（P<0.001）。在多变量分析中，年龄<50 岁、当前吸烟、无其他冠状动脉危险因素、无多血管疾病、病变严重程度降低、血管直径较大和分叉附近是与斑块侵蚀显著相关的因素。分叉附近和当前吸烟在男性中尤为显著，而年龄<50 岁在女性中最具预测性。
斑块侵蚀是 STEMI 患者中一种可预测的临床实体，与斑块破裂不同，应考虑危险因素在斑块侵蚀中的性别特异性作用。
