Tashiro Hiroshi, Tanaka Akihito, Ishii Hideki, Sakakibara Keisuke, Tobe Akihiro, Kataoka Takashi, Miki Yusuke, Hitora Yusuke, Niwa Kiyoshi, Furusawa Kenji, Murohara Toyoaki
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Int J Cardiol. 2020 Apr 15;305:5-10. doi: 10.1016/j.ijcard.2020.01.072. Epub 2020 Jan 30.
An integrated backscatter (IB) intravascular ultrasound (IVUS) provides an information about tissue components and vulnerability of coronary plaques. The presence of vulnerable plaque in non-culprit lesion is associated with future clinical events. The purpose of this study was to assess the association between the characteristics of non-culprit left main coronary artery (LMCA) plaques evaluated by IB-IVUS and long-term clinical outcomes in patients undergoing percutaneous coronary intervention (PCI).
Among the patients who underwent non-LMCA PCI, we studied 366 patients with adequate LMCA IVUS images. Conventional and IB-IVUS analyses of the LMCA segment were performed. Lipid-rich large plaque was defined as the presence of both a lager plaque volume and a higher percentage of the lipid component than the obtained median values. Major adverse cardiovascular events (MACE) included cardiac death, myocardial infarction, and unplanned revascularization.
The mean age of the patients was 68.5 ± 10.2 years, 79.8% were men. Median follow-up period was 6.0 years (IQR: 4.2-8.1 years). The incidence of MACE was significantly higher in patients with lipid-rich large plaques (P = .006). The incidence rates of cardiac death, myocardial infarction, and unplanned revascularization were significantly higher in patients with lipid-rich large plaques (P = .02, 0.004, and 0.02, respectively). Multivariate Cox regression analysis showed that the presence of a lipid-rich large plaque was significantly associated with MACE (HR: 1.74; 95%CI: 1.17-2.58; P = .006).
The presence of lipid-rich large plaques in a non-culprit LMCA can be associated with the long-term MACE in patients who have undergone PCI.
背向散射积分（IB）血管内超声（IVUS）可提供有关冠状动脉斑块的组织成分和易损性的信息。非罪犯病变中易损斑块的存在与未来临床事件相关。本研究的目的是评估经IB-IVUS评估的非罪犯左主干冠状动脉（LMCA）斑块特征与接受经皮冠状动脉介入治疗（PCI）患者的长期临床结局之间的关联。
在接受非LMCA PCI的患者中，我们研究了366例有足够LMCA-IVUS图像的患者。对LMCA节段进行了传统和IB-IVUS分析。富含脂质的大斑块定义为斑块体积较大且脂质成分百分比高于所得中位数。主要不良心血管事件（MACE）包括心源性死亡、心肌梗死和非计划血管重建。
患者的平均年龄为68.5±10.2岁，男性占79.8%。中位随访期为6.0年（四分位间距：4.2 - 8.1年）。富含脂质的大斑块患者的MACE发生率显著更高（P = 0.006）。富含脂质的大斑块患者的心源性死亡、心肌梗死和非计划血管重建的发生率显著更高（分别为P = 0.02、0.004和0.02）。多变量Cox回归分析表明，富含脂质的大斑块的存在与MACE显著相关（风险比：1.74；95%置信区间：1.17 - 2.58；P = 0.006）。
非罪犯LMCA中存在富含脂质的大斑块可能与接受PCI患者的长期MACE相关。
