Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 261# Huansha Road, Shangcheng District, Hangzhou, 310006, China.
Department of Cardiology, Wenzhou People's Hospital, Wenzhou, China.
Int J Cardiovasc Imaging. 2020 Jun;36(6):1003-1011. doi: 10.1007/s10554-020-01794-9. Epub 2020 Feb 20.
Premature coronary artery disease (CAD) studies rarely involve coronary plaque characterization. We characterize coronary plaque tissue by radiofrequency intravascular ultrasound (IVUS) in patients with premature CAD. From July 2015 to December 2017, 220 patients from the Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine with first occurrence of angina or myocardial infarction within 3 months were enrolled. Patients with premature CAD (n = 47, males aged < 55 years, and females aged < 65 years) or later CAD (n = 155) were retrospectively compared for cardiovascular risk factors, laboratory examination findings, coronary angiography data, gray-scale IVUS, and iMap-IVUS. The mean age was 53.53 ± 7.24 vs. 70.48 ± 8.74 years (p < 0.001). The groups were similar for traditional coronary risk factors except homocysteine (18.60 ± 5.15 vs. 17.08 ± 4.27 µmol/L, p = 0.043). After matching for baseline characteristics, LDL cholesterol (LDL-C) was higher for premature CAD than later CAD (2.50 ± 0.96 vs. 2.17 ± 0.80 mmol/L, p = 0.019). Before the matching procedure, the premature CAD group had shorter target lesion length [18.50 (12.60-32.00) vs. 27.90 (18.70-37.40) mm, p = 0.002], less plaque volume [175.59 (96.60-240.50) vs. 214.73 (139.74-330.00) mm, p = 0.013] than the later CAD group. After the matching procedure, the premature CAD group appeared to be less plaque burden (72.69 ± 9.99 vs. 74.85 ± 9.80%, p = 0.005), and positive remodeling (1.03 ± 0.12 vs. 0.94 ± 0.18, p = 0.034), and lower high risk feature incidence (p = 0.006) than the later CAD group. At the plaque's minimum lumen, premature CAD had more fibrotic (p < 0.001), less necrotic (p = 0.001) and less calcified areas (p = 0.012). Coronary plaque tissue was more fibrotic with less necrotic and calcified components in premature than in later CAD, and the range and degree of atherosclerosis were significantly lower.
早发冠心病（CAD）的研究很少涉及冠状动脉斑块特征。我们通过射频血管内超声（IVUS）对早发 CAD 患者的冠状动脉斑块组织进行特征描述。
2015 年 7 月至 2017 年 12 月，浙江医科大学附属杭州第一人民医院心内科首次发生心绞痛或心肌梗死 3 个月内的 220 例患者入组。将早发 CAD（n=47，男性年龄<55 岁，女性年龄<65 岁）或晚发 CAD（n=155）患者进行回顾性比较，分析心血管危险因素、实验室检查结果、冠状动脉造影数据、灰阶 IVUS 和 iMap-IVUS。
患者平均年龄分别为 53.53±7.24 岁和 70.48±8.74 岁（p<0.001）。两组除同型半胱氨酸（18.60±5.15 比 17.08±4.27 μmol/L，p=0.043）外，传统冠状动脉危险因素相似。
在匹配基线特征后，早发 CAD 患者的 LDL 胆固醇（LDL-C）高于晚发 CAD（2.50±0.96 比 2.17±0.80 mmol/L，p=0.019）。在匹配前，早发 CAD 组的靶病变长度更短[18.50（12.60-32.00）比 27.90（18.70-37.40）mm，p=0.002]，斑块体积更小[175.59（96.60-240.50）比 214.73（139.74-330.00）mm，p=0.013]。
匹配后，早发 CAD 组的斑块负荷（72.69±9.99 比 74.85±9.80%，p=0.005）、正性重构（1.03±0.12 比 0.94±0.18，p=0.034）和高危特征发生率（p=0.006）均低于晚发 CAD 组。在斑块最小管腔处，早发 CAD 组的纤维组织更多（p<0.001），坏死组织更少（p=0.001），钙化组织更少（p=0.012）。
早发 CAD 患者的冠状动脉斑块组织中，纤维组织更多，坏死和钙化组织更少，动脉粥样硬化的范围和程度明显较低。
