Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 800, Boston, MA, 02114, USA.
Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
J Thromb Thrombolysis. 2020 Nov;50(4):895-902. doi: 10.1007/s11239-020-02076-w.
Recent studies have shown that healed plaque at the culprit lesion detected by optical coherence tomography (OCT) is a sign of pan-vascular vulnerability and advanced atherosclerosis. However, the clinical significance of healed plaque is unknown. A total of 265 patients who had OCT imaging of a culprit vessel and 2-year clinical follow-up data were included. Patients were stratified based on the presence or absence of a layered plaque phenotype, defined as layers of different optical density by OCT at either culprit or non-culprit lesions. The association between layered plaque and major adverse cardiac events (MACE), defined as cardiac death, acute coronary syndromes (ACS), or revascularization, was studied. Among 265 patients, 96 (36.2%) had the layered plaque phenotype. Layered plaque was more frequently observed in stable angina pectoris patients than in ACS patients (57.8%vs. 25.1%, p < 0.001). The average clinical follow-up period was 672 ± 172 days. Cumulative MACE was significantly higher in patients with layered plaque (p = 0.041), which was primarily driven by the high revascularization rate at 2 years (p = 0.002). Multivariate regression analysis showed that presence of layered plaque and low-density lipoprotein cholesterol levels were independently associated with an increased risk of revascularization (p = 0.026, p = 0.008, respectively). Patients with healed plaque in the culprit vessel had a higher incidence of revascularization, as compared to those without healed plaque, at 2 years.
最近的研究表明，光学相干断层扫描（OCT）检测到的罪犯病变处的愈合斑块是血管脆弱性和动脉粥样硬化进展的标志。然而，愈合斑块的临床意义尚不清楚。共纳入 265 例接受罪犯血管 OCT 成像和 2 年临床随访数据的患者。根据是否存在分层斑块表型对患者进行分层，分层斑块表型定义为 OCT 在罪犯或非罪犯病变处显示不同光学密度的层。研究了分层斑块与主要不良心脏事件（MACE）之间的关系，MACE 定义为心脏死亡、急性冠脉综合征（ACS）或血运重建。在 265 例患者中，96 例（36.2%）存在分层斑块表型。与 ACS 患者相比，稳定型心绞痛患者更常出现分层斑块（57.8%比 25.1%，p<0.001）。平均临床随访时间为 672±172 天。分层斑块患者的累积 MACE 显著更高（p=0.041），这主要是由于 2 年内血运重建率较高（p=0.002）。多变量回归分析显示，存在分层斑块和低密度脂蛋白胆固醇水平与血运重建风险增加独立相关（p=0.026，p=0.008）。与无愈合斑块的患者相比，罪犯血管中有愈合斑块的患者在 2 年内血运重建的发生率更高。
