非 ST 段抬高型急性冠状动脉综合征罪犯病变组织特征与心肌组织水平灌注：EARLY-MYO-ACS 研究。
Tissue characteristics of culprit lesion and myocardial tissue-level perfusion in non-ST-segment elevation acute coronary syndromes: The EARLY-MYO-ACS study.
机构信息
Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China.
The First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325035, China.
出版信息
Int J Cardiol. 2019 Jul 15;287:32-38. doi: 10.1016/j.ijcard.2019.02.010. Epub 2019 Feb 8.
OBJECTIVE
The impact of tissue characteristics of culprit lesion on myocardial tissue-level perfusion in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) remains unclear. EARLY-MYO-ACS study was a prospective observational study to investigate the relationship between pre-percutaneous coronary intervention (PCI) culprit plaque characteristics and post-PCI myocardial tissue-level perfusion with iMap intravascular ultrasound (IVUS) in NSTE-ACS patients.
METHODS
A total of 408 patients with coronary artery disease (246 NSTE-ACS and 162 stable angina pectoris) undergoing coronary angiography, grayscale-IVUS and iMap-IVUS were enrolled. Tissue characteristics of culprit lesion were analyzed by the iMap-IVUS system as fibrotic, lipidic, necrotic, or calcified tissue. Epicardial coronary perfusion was assessed by TIMI flow grade (TFG), and myocardial tissue-level perfusion was assessed by both TIMI myocardial perfusion grade (TMPG) and TIMI myocardial perfusion frame count (TMPFC).
RESULTS
The percentages of necrotic volume within the culprit lesion were significantly greater in NSTE-ACS than that in stable angina pectoris (20.8 ± 7.9% vs. 15.9 ± 7.2%, P < 0.001). Patients with impaired epicardial coronary perfusion (TFG 0-2) had higher necrotic percentage within the culprit lesion than those with normal TFG (27.9 ± 7.3% vs. 19.6 ± 7.4%, P < 0.001). Moreover, patients with impaired myocardial tissue-level perfusion (TMPG 0-2) had greater necrotic percentages within the culprit lesion than those with normal TMPG (25.0 ± 8.1% vs. 18.4 ± 6.7%, P < 0.001). Multivariate analysis revealed that iMap-derived necrotic volume percentage was independently associated with reduced post-PCI TMPG (OR 2.39 [95% CI 1.60 to 3.57], P = 0.009) and impaired post-PCI TMPFC (OR 2.89 [95% CI 1.62 to 5.16], P = 0.008). The ROC curve showed that the optimal threshold of necrotic volume percentage was 20.09% and 21.03% to predict impaired TMPG and TMPFC, respectively.
CONCLUSION
Increased necrotic fraction of the culprit lesion is independently associated with impaired myocardial tissue-level perfusion in NSTE-ACS patients. Thus, plaque composition assessed by pre-PCI iMap-IVUS could predict post-PCI impaired myocardial tissue-level perfusion in NSTE-ACS patients (Trial Registration: ChiCTR-OCH-13003046).
目的
罪犯病变的组织特征对非 ST 段抬高型急性冠状动脉综合征（NSTE-ACS）患者心肌组织水平灌注的影响尚不清楚。EARLY-MYO-ACS 研究是一项前瞻性观察性研究，旨在探讨 NSTE-ACS 患者经皮冠状动脉介入治疗（PCI）前罪犯斑块特征与 PCI 后心肌组织水平灌注与 iMap 血管内超声（IVUS）的关系。
方法
共纳入 408 例接受冠状动脉造影、灰阶-IVUS 和 iMap-IVUS 的冠心病患者（246 例 NSTE-ACS 和 162 例稳定型心绞痛）。通过 iMap-IVUS 系统分析罪犯病变的组织特征，分为纤维组织、脂质组织、坏死组织或钙化组织。通过 TIMI 血流分级（TFG）评估心外膜冠状动脉灌注，通过 TIMI 心肌灌注分级（TMPG）和 TIMI 心肌灌注帧数（TMPFC）评估心肌组织水平灌注。
结果
NSTE-ACS 患者罪犯病变内坏死体积百分比明显高于稳定型心绞痛患者（20.8±7.9% vs. 15.9±7.2%，P<0.001）。心外膜冠状动脉灌注受损（TFG 0-2）患者的罪犯病变内坏死百分比高于 TFG 正常患者（27.9±7.3% vs. 19.6±7.4%，P<0.001）。此外，心肌组织水平灌注受损（TMPG 0-2）患者的罪犯病变内坏死百分比高于 TMPG 正常患者（25.0±8.1% vs. 18.4±6.7%，P<0.001）。多变量分析显示，iMap 衍生的坏死体积百分比与 PCI 后 TMPG 降低（OR 2.39[95%CI 1.60 至 3.57]，P=0.009）和 PCI 后 TMPFC 受损（OR 2.89[95%CI 1.62 至 5.16]，P=0.008）独立相关。ROC 曲线显示，坏死体积百分比的最佳阈值分别为 20.09%和 21.03%，以预测 TMPG 和 TMPFC 受损。
结论
罪犯病变中坏死分数的增加与 NSTE-ACS 患者心肌组织水平灌注受损独立相关。因此，PCI 前 iMap-IVUS 评估的斑块成分可预测 NSTE-ACS 患者 PCI 后心肌组织水平灌注受损（试验注册：ChiCTR-OCH-13003046）。
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