Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama 641-8509, Japan.
Eur Heart J Cardiovasc Imaging. 2020 Feb 1;21(2):202-209. doi: 10.1093/ehjci/jez079.
While patients with acute coronary syndrome (ACS) presenting with non-obstructive coronary artery disease (CAD) are at high risk for cardiovascular mortality and morbidity, detailed lesion characteristics are unclear. The aim of this study was to investigate the lesion characteristics and prognosis of ACS with non-obstructive CAD.
This study consisted of 82 consecutive ACS patients without obstructive CAD who underwent optical coherence tomography (OCT). Based on the presence of high-risk lesions (HL) in the culprit artery, we classified the patients into two groups: HL group and non-high-risk lesions (NHL) group. A systematic clinical follow-up was performed at our outpatient clinic for up to 24 months. Our endpoint was recurrence of ACS with obstructive CAD. OCT revealed that 42 (51.2%) of 82 patients had hidden HL in the culprit artery, including ruptured plaque (15.9%), calcified nodule (11.0%), spontaneous coronary artery dissection (8.5%), lone thrombus (8.5%), thin-cap fibroatheroma (6.1%), and plaque erosion (1.2%). During angiography, 5 (11.9%) HL patients complained of chest pain without ST elevation. Patients in the HL group had poorer prognoses than those in the other groups (P = 0.040).
Hidden high-risk lesions accompany ACS patients without obstructive CAD, resulting in poorer outcomes. Vascular injury itself might provoke acute chest pain.
急性冠状动脉综合征（ACS）患者伴有非阻塞性冠状动脉疾病（CAD）时心血管死亡率和发病率风险较高，但详细的病变特征尚不清楚。本研究旨在探讨非阻塞性 CAD 合并 ACS 的病变特征和预后。
本研究纳入 82 例连续非阻塞性 CAD 的 ACS 患者，均接受光学相干断层扫描（OCT）检查。根据罪犯血管中高危病变（HL）的存在，我们将患者分为 HL 组和非高危病变（NHL）组。在我们的门诊进行了长达 24 个月的系统临床随访。我们的终点是复发性伴有阻塞性 CAD 的 ACS。OCT 显示 82 例患者中的 42 例（51.2%）罪犯动脉存在隐匿性 HL，包括破裂斑块（15.9%）、钙化结节（11.0%）、自发性冠状动脉夹层（8.5%）、孤立性血栓（8.5%）、薄帽纤维粥样瘤（6.1%）和斑块侵蚀（1.2%）。在血管造影中，5 例（11.9%）HL 患者胸痛但无 ST 段抬高。HL 组患者的预后较其他组差（P=0.040）。
非阻塞性 CAD 合并 ACS 患者存在隐匿性高危病变，预后较差。血管损伤本身可能引发急性胸痛。
