Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
Atherosclerosis. 2019 Oct;289:94-100. doi: 10.1016/j.atherosclerosis.2019.08.011. Epub 2019 Aug 22.
About 20% of patients with ST-segment elevated myocardial infarction (STEMI) are young adults. Morphological characteristics of culprit lesion in young STEMI patients have not been systematically evaluated in vivo. The present study aimed to investigate culprit lesion characteristics in young patients versus older patients using optical coherence tomography (OCT).
1442 STEMI patients who underwent OCT examination of culprit lesion were included and divided into young group (age ≤50 years, n = 400) and older group (age >50 years, n = 1042). Clinical characteristics, angiography and OCT findings were compared between the two groups.
Culprit lesions in STEMI patients aged ≤50 years had more plaque erosion (32.0% vs. 21.1%, p < 0.001) and larger minimal lumen area (2.3 ± 1.7 mmvs. 1.9 ± 1.1 mm, p < 0.001) than in those aged >50 years. As compared with older patients, lipid rich plaque (80.5% vs. 87.2%, p = 0.001), thin cap fibroatheroma (TCFA, 59.5% vs. 69.5%, p < 0.001), calcification (31.3% vs. 48.7%, p < 0.001), spotty calcification (25.3% vs. 36.1%, p < 0.001) and cholesterol crystals (26.3% vs. 38.4%, p < 0.001) were less frequently observed in young patients. A gradient increase in typical plaque vulnerability was observed from age ≤50 years to 50-70 years to >70 years. In multivariate regression analysis, age ≤50 years was independently associated with less frequency of plaque rupture, TCFA, spotty calcification, cholesterol crystals and smaller lumen area stenosis.
Morphological characteristics of culprit lesion in young STEMI patients were different from those in older patients. Patients aged ≤50 years had more plaque erosion and less vulnerable plaque features.
大约 20%的 ST 段抬高型心肌梗死（STEMI）患者为年轻成年人。年轻 STEMI 患者罪犯病变的形态学特征尚未在体内得到系统评估。本研究旨在通过光学相干断层扫描（OCT）研究年轻患者与老年患者的罪犯病变特征。
纳入 1442 例接受罪犯病变 OCT 检查的 STEMI 患者，分为年轻组（年龄≤50 岁，n=400）和老年组（年龄＞50 岁，n=1042）。比较两组患者的临床特征、血管造影和 OCT 结果。
年龄≤50 岁的 STEMI 患者的罪犯病变中，斑块侵蚀（32.0% vs. 21.1%，p＜0.001）和最小管腔面积较大（2.3±1.7mm vs. 1.9±1.1mm，p＜0.001）。与老年患者相比，脂质丰富斑块（80.5% vs. 87.2%，p=0.001）、薄帽纤维粥样斑块（TCFA，59.5% vs. 69.5%，p＜0.001）、钙化（31.3% vs. 48.7%，p＜0.001）、点状钙化（25.3% vs. 36.1%，p＜0.001）和胆固醇结晶（26.3% vs. 38.4%，p＜0.001）的发生率较低。从年龄≤50 岁到 50-70 岁再到＞70 岁，典型斑块易损性呈梯度增加。多变量回归分析显示，年龄≤50 岁与斑块破裂、TCFA、点状钙化、胆固醇结晶和管腔面积狭窄程度较小独立相关。
年轻 STEMI 患者罪犯病变的形态学特征与老年患者不同。年龄≤50 岁的患者斑块侵蚀较多，易损斑块特征较少。
