Shishikura Daisuke, Kataoka Yu, Di Giovanni Giuseppe, Takata Kohei, Scherer Daniel J, Andrews Jordan, Psaltis Peter J, Puri Rishi, Wolski Kathy, Nissen Steven E, Nicholls Stephen J
Heart Health Them, South Australian Health & Medical Research Institute, University of Adelaide, North Terrace, Adelaide, SA 5001, Australia.
Department of Cardiovascular Medicine, Cleveland Clinic Coordinating Centre for Clinical Research, Euclid Avenue, Cleveland, OH 44195, USA.
Eur Heart J. 2020 Aug 14;41(31):2965-2973. doi: 10.1093/eurheartj/ehaa173.
Intravascular ultrasound (IVUS) imaging can visualize vulnerable plaque features including attenuation (AP) and echolucency (ELP). While IVUS-derived vulnerable plaque features associate with microvascular obstruction during percutaneous coronary intervention, the relationship between these plaque features and clinical outcomes has not been established. This analysis aimed to evaluate the association of AP/ELP with cardiovascular events.
Serial IVUS imaging was reviewed in 1497 patients, followed for 18-24 months, with coronary artery disease from two clinical trials. Attenuated plaque and ELP were identified to measure each characteristics (AP arc, ELP area, and lengths), which permitted calculation of an AP index (API) and ELP volume. Attenuated plaque/ELP progression was defined as patients with any increase of API or ELP volume on serial imaging. The major cardiovascular events (MACEs) were defined as death, myocardial infarction, stroke, and coronary revascularization. AP or ELP was identified in 282 patients (18.8%) at baseline and 160 (10.7%) patients demonstrated an increase in AP or ELP at follow-up. The incidence of MACE was higher in patients with baseline AP/ELP than those without (8.2% vs. 3.9%, P = 0.002). Patients with AP/ELP progression were more likely to be acute coronary syndrome (41.9 vs. 33.2%, P = 0.03) and have greater baseline percent atheroma volume (40.0% vs. 35.8%, P < 0.001) than those without. On multivariable analysis, AP/ELP progression was more strongly associated with MACE [baseline AP/ELP: hazard ratio (HR) 1.76, 95% confidence interval (CI) 1.05-2.97, AP/ELP progression: HR 2.19, 95% CI 1.24-3.86].
Attenuation/ELP progression was associated with a higher prevalence of cardiovascular events, supporting a potential role for the identification of high-risk vulnerable plaques in patients with coronary artery disease.
血管内超声（IVUS）成像可显示易损斑块特征，包括衰减（AP）和透声性（ELP）。虽然IVUS衍生的易损斑块特征与经皮冠状动脉介入治疗期间的微血管阻塞相关，但这些斑块特征与临床结局之间的关系尚未确立。本分析旨在评估AP/ELP与心血管事件的关联。
回顾了来自两项临床试验的1497例冠心病患者的系列IVUS成像，随访18 - 24个月。识别出衰减斑块和ELP以测量每个特征（AP弧、ELP面积和长度），从而计算AP指数（API）和ELP体积。衰减斑块/ELP进展定义为系列成像中API或ELP体积有任何增加的患者。主要心血管事件（MACE）定义为死亡、心肌梗死、中风和冠状动脉血运重建。基线时282例患者（18.8%）存在AP或ELP，随访时160例患者（10.7%）的AP或ELP增加。基线存在AP/ELP的患者MACE发生率高于无AP/ELP的患者（8.2%对3.9%，P = 0.002）。与无AP/ELP进展的患者相比，有AP/ELP进展的患者更可能为急性冠状动脉综合征（41.9%对33.2%，P = 0.03）且基线粥样斑块体积百分比更高（40.0%对35.8%，P < 0.001）。多变量分析显示，AP/ELP进展与MACE的关联更强[基线AP/ELP：风险比（HR）1.76，95%置信区间（CI）1.05 - 2.97，AP/ELP进展：HR 2.19，95% CI 1.24 - 3.86]。
衰减/ELP进展与心血管事件的较高发生率相关，支持在冠心病患者中识别高危易损斑块具有潜在作用。
