Kochergin N A, Kochergina A M, Khorlampenko A A, Ganyukov V I, Shilov A A, Barbarash O L
Scientific Research Institute for Complex Problems of Cardiovascular Diseases, Kemerovo.
Kemerovo State Medical University, Kemerovo.
Kardiologiia. 2019 Nov 6;60(2):69-74. doi: 10.18087/cardio.2020.2.n467.
A key objective of modern cardiology is the assessment of acute coronary syndrome (ACS) risk in patients with coronary artery disease (CAD) to develop preventive measures and choose optimal treatment strategies.
Detect vulnerable plaques of non-target coronary arteries in patients with stable CAD during routine percutaneous coronary intervention using virtual-histology intravascular ultrasound (VH-IVUS) and view their morphology over time.
The prospective observational cohort study included 58 patients with stable CAD. After stenting of a target vessel, VH-IVUS was carried out in proximal and middle segments (6-8 cm) of a non-target coronary artery with no significant stenosis according to coronary angiography. Twelve months later, all patients underwent coronary angiography with re-IVUS of previously detected lesions. Death, myocardial infarction, rehospitalization, and unplanned myocardial revascularization due to vulnerable plaques were the endpoints of the study.
IVUS with virtual histology revealed 58 lesions of non-target coronary arteries in 56 (96.5 %) patients. Two patients had no lesions in non-target coronary arteries. A large necrotic core with thin cap (thin-cap fibroatheroma) was detected in 12 (20.7 %) plaques, six of which had additional ACS risk criteria (stenosis area >70 % and / or lumen area <4 mm2). Within the 12‑month follow-up period, three patients (one with a vulnerable plaque in IVUS) were hospitalized with a clinical picture of ACS. One cardiac death was registered in a patient with the IVUS vulnerable plaque. 7 of 12 vulnerable plaques stabilized in 12 months.
现代心脏病学的一个关键目标是评估冠状动脉疾病（CAD）患者的急性冠状动脉综合征（ACS）风险，以制定预防措施并选择最佳治疗策略。
在常规经皮冠状动脉介入治疗期间，使用虚拟组织学血管内超声（VH-IVUS）检测稳定型CAD患者非靶冠状动脉的易损斑块，并观察其随时间的形态变化。
前瞻性观察队列研究纳入了58例稳定型CAD患者。在对靶血管进行支架置入后，根据冠状动脉造影，对无明显狭窄的非靶冠状动脉的近端和中段（6-8cm）进行VH-IVUS检查。12个月后，所有患者均接受冠状动脉造影及对先前检测到的病变进行再次IVUS检查。研究终点为因易损斑块导致的死亡、心肌梗死、再次住院以及非计划性心肌血运重建。
虚拟组织学IVUS在56例（96.5%）患者中发现了58个非靶冠状动脉病变。2例患者非靶冠状动脉无病变。在12个（20.7%）斑块中检测到有大坏死核心且帽薄的病变（薄帽纤维粥样瘤），其中6个斑块有额外的ACS风险标准（狭窄面积>70%和/或管腔面积<4mm²）。在12个月的随访期内，3例患者（1例IVUS检查有易损斑块）因ACS临床表现住院。1例IVUS检查有易损斑块的患者发生心源性死亡。12个易损斑块中有7个在12个月内稳定。
1）所呈现的数据表明，接受支架置入的稳定型CAD患者中非靶冠状动脉易损斑块的发生率较高（20.7%）；2）2例（16.6%）有易损斑块的患者在12个月的随访期内达到研究终点（死亡和再次住院）；3）对非靶冠状动脉粥样硬化斑块随时间的分析表明，超过一半的病例（12个中的7个）易损斑块稳定且未引发ACS；4）根据IVUS检查不易损的斑块在12个月的随访期内不太可能发生不稳定。
