Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Division of Cardiology, Kyung Hee University, Seoul, South Korea.
Int J Cardiol. 2019 Aug 1;288:12-16. doi: 10.1016/j.ijcard.2019.03.039. Epub 2019 Mar 22.
Although an in vivo diagnosis of coronary plaque erosion has become possible by optical coherence tomography (OCT), angiographic characteristics of erosion have not been studied. The aim of this study was to investigate the angiographic features of plaque erosion in patients with non-ST elevation acute coronary syndromes (NSTE-ACS).
Patients with NSTE-ACS who underwent OCT of the culprit lesion were collected at 11 institutions from 6 countries. Patients were classified as erosion or non-erosion based on OCT images. Angiographic features of both groups were compared.
Among 494 cases with NSTE-ACS, 242 had plaque erosion and 252 had non-erosion. Compared to non-erosion group, erosion patients had less multivessel disease (28.5% vs. 49.6%, p < 0.001), lower Jeopardy score (4.2 vs. 5.0, p < 0.001), lower Gensini score (21.3 vs. 25.6, p = 0.014), and lower Syntax score (8.9 vs. 11.5, p < 0.001). With regard to the culprit lesion morphology, plaque erosion group had smaller reference diameter (2.8 mm vs. 3.0 mm, p = 0.032), less frequent type B2/C lesions (51.2% vs. 71.8%, p < 0.001), and lower prevalence of calcification (4.1% vs. 13.9%, p < 0.001) and thrombus (16.5% vs. 28.2%, p = 0.002). In the mid left anterior descending artery (LAD), erosion was significantly more frequent than non-erosion (30.2% vs. 21.8%, p = 0.034).
Patients with NSTE-ACS caused by plaque erosion have less complex angiographic features both at the 3-vessel level and at the culprit lesion level. Plaque erosion was frequently found in the mid LAD.
虽然光学相干断层扫描（OCT）已经可以对冠状动脉斑块侵蚀进行体内诊断，但尚未对侵蚀的血管造影特征进行研究。本研究旨在探讨非 ST 段抬高型急性冠状动脉综合征（NSTE-ACS）患者的斑块侵蚀的血管造影特征。
在来自 6 个国家的 11 个机构收集了接受罪犯病变 OCT 的 NSTE-ACS 患者。根据 OCT 图像将患者分为侵蚀组或非侵蚀组。比较两组的血管造影特征。
在 494 例 NSTE-ACS 患者中，242 例存在斑块侵蚀，252 例不存在斑块侵蚀。与非侵蚀组相比，侵蚀组多支血管疾病的发生率较低（28.5% vs. 49.6%，p < 0.001），危险评分（4.2 vs. 5.0，p < 0.001）、Gensini 评分（21.3 vs. 25.6，p = 0.014）和 Syntax 评分（8.9 vs. 11.5，p < 0.001）较低。就罪犯病变形态而言，斑块侵蚀组参考直径较小（2.8mm vs. 3.0mm，p = 0.032），B2/C 型病变发生率较低（51.2% vs. 71.8%，p < 0.001），钙化（4.1% vs. 13.9%，p < 0.001）和血栓（16.5% vs. 28.2%，p = 0.002）的发生率较低。在左前降支（LAD）中段，侵蚀比非侵蚀更常见（30.2% vs. 21.8%，p = 0.034）。
NSTE-ACS 患者的斑块侵蚀在三支血管水平和罪犯病变水平的血管造影特征均较不复杂。LAD 中段易发生斑块侵蚀。
