Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
JACC Cardiovasc Interv. 2019 Mar 25;12(6):531-540. doi: 10.1016/j.jcin.2018.12.013.
This study conducted detailed analysis of calcified culprit plaques in patients with acute coronary syndromes (ACS).
Calcified plaques as an underlying pathology in patients with ACS have not been systematically studied.
From 1,241 patients presenting with ACS who had undergone pre-intervention optical coherence tomography imaging, 157 (12.7%) patients were found to have a calcified plaque at the culprit lesion. Calcified plaque was defined as a plaque with superficial calcification at the culprit site without evidence of ruptured lipid plaque.
Three distinct types were identified: eruptive calcified nodules, superficial calcific sheet, and calcified protrusion (prevalence of 25.5%, 67.4%, and 7.1%, respectively). Eruptive calcified nodules were frequently located in the right coronary arteries (44.4%), whereas superficial calcific sheet was most frequently found in the left anterior descending coronary arteries (68.4%) (p = 0.012). Calcification index (mean calcification arc × calcification length) was greatest in eruptive calcified nodules, followed by superficial calcific sheet, and smallest in calcified protrusion (median 3,284.9 [interquartile range (IQR): 2,113.3 to 5,385.3] vs. 1,644.3 [IQR: 1,012.4 to 3,058.7] vs. 472.5 [IQR: 176.7 to 865.2]; p < 0.001). The superficial calcific sheet group had the highest peak post-intervention creatine kinase values among the groups (eruptive calcified nodules vs. superficial calcific sheet vs. calcified protrusion: 241 [IQR: 116 to 612] IU/l vs. 834 [IQR: 141 to 3,394] IU/l vs. 745 [IQR: 69 to 1,984] IU/l; p = 0.032).
Three distinct types of calcified culprit plaques are identified in patients with ACS. Superficial calcific sheet, which is frequently located in the left anterior descending coronary artery, is the most prevalent type and is also associated with greatest post-intervention myocardial damage. (Identification of Predictors for Coronary Plaque Erosion in Patients With Acute Coronary Syndrome; NCT03479723).
本研究对急性冠脉综合征（ACS）患者的钙化罪犯斑块进行了详细分析。
ACS 患者的钙化斑块作为潜在病理学尚未得到系统研究。
在 1241 例接受介入前光学相干断层成像检查的 ACS 患者中，发现 157 例（12.7%）患者的罪犯病变存在钙化斑块。钙化斑块定义为罪犯部位存在表面钙化的斑块，无破裂脂质斑块的证据。
发现三种不同类型：爆发性钙化结节、浅表钙化片和钙化突起（分别为 25.5%、67.4%和 7.1%）。爆发性钙化结节多位于右冠状动脉（44.4%），而浅表钙化片多位于左前降支冠状动脉（68.4%）（p=0.012）。钙化指数（平均钙化弧×钙化长度）在爆发性钙化结节中最大，其次是浅表钙化片，在钙化突起中最小（中位数 3284.9[四分位距（IQR）：2113.3 至 5385.3] vs. 1644.3[IQR：1012.4 至 3058.7] vs. 472.5[IQR：176.7 至 865.2]；p<0.001）。在三组中，浅表钙化片组的峰值肌酸激酶升高幅度最高（爆发性钙化结节组 vs. 浅表钙化片组 vs. 钙化突起组：241[IQR：116 至 612]IU/L vs. 834[IQR：141 至 3394]IU/L vs. 745[IQR：69 至 1984]IU/L；p=0.032）。
ACS 患者中存在三种不同类型的钙化罪犯斑块。浅表钙化片常见于左前降支冠状动脉，是最常见的类型，也与介入后最大的心肌损伤相关。（识别急性冠脉综合征患者冠脉斑块侵蚀的预测因子；NCT03479723）。
