ElFaramawy Amr, Youssef Mina, Abdel Ghany Mohamed, Shokry Khaled
Department of Cardiovascular Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt.
Cardiology Department, Aswan Heart Center, Aswan, Egypt.
Egypt Heart J. 2018 Jun;70(2):95-100. doi: 10.1016/j.ehj.2017.12.002. Epub 2017 Dec 27.
This study was designed to utilize frequency-domain optical coherence tomography (FD-OCT) for assessment of plaque characteristics and vulnerability in patients with acute coronary syndrome (ACS) compared to stable coronary artery disease (SCAD).
We enrolled 48 patients; divided into an ACS-group (27 patients) and SCAD-group (21 patients) according to their clinical presentation. Hypertension and diabetes mellitus were more prevalent in SCAD group. Patients with ACS showed higher frequency of lipid-rich plaques (96.3% vs. 66.7%, P = .015), lower frequency of calcium plaques (7.4% vs. 57.1%, P < .001), and fibrous plaques (14.8% vs. 81%, P < .001) when compared with SCAD patients. The TCFA (defined as lipid-rich plaque with cap thickness <65 μm) identified more frequently (33.3% vs. 14.3%, P = .185), with a trend towards thinner median fibrous cap thickness (70 (50-180) µm vs. 100 (50-220) µm, P = .064) in ACS group. Rupture plaque (52% vs. 14.3%, P = .014), plaque erosion (18.5% vs. 0%, P = .059) and intracoronary thrombus (92.6% vs. 14.3%, P < .001) were observed more frequently in ACS group, while cholesterol crystals were identified frequently in patients with SCAD (0.0% vs. 33.3%, P = .002).
The current FD-OCT study demonstrated the differences of plaque morphology and identified distinct lesion characteristics between patients with ACS and those with SCAD. These findings could explain the clinical presentation of patients in both groups.
本研究旨在利用频域光学相干断层扫描（FD - OCT）评估急性冠状动脉综合征（ACS）患者与稳定型冠状动脉疾病（SCAD）患者的斑块特征及易损性。
我们纳入了48例患者；根据临床表现分为ACS组（27例患者）和SCAD组（21例患者）。高血压和糖尿病在SCAD组更为常见。与SCAD患者相比，ACS患者富含脂质斑块的发生率更高（96.3%对66.7%，P = 0.015），钙化斑块（7.4%对57.1%，P < 0.001）和纤维斑块（14.8%对81%，P < 0.001）的发生率更低。薄纤维帽粥样斑块（定义为帽厚度<65μm的富含脂质斑块）在ACS组中更频繁地被识别（33.3%对14.3%，P = 0.185），且ACS组的纤维帽厚度中位数有变薄的趋势（70（50 - 180）μm对100（50 - 220）μm，P = 0.064）。破裂斑块（52%对14.3%，P = 0.014）、斑块侵蚀（18.5%对0%，P = 0.059）和冠状动脉内血栓（92.6%对14.3%，P < 0.001）在ACS组中更频繁地被观察到，而胆固醇结晶在SCAD患者中更频繁地被识别（0.0%对33.3%，P = 0.002）。
当前的FD - OCT研究显示了ACS患者和SCAD患者之间斑块形态的差异，并确定了不同的病变特征。这些发现可以解释两组患者的临床表现。
