Kurihara Osamu, Takano Masamichi, Soeda Tsunenari, Fracassi Francesco, Araki Makoto, Nakajima Akihiro, McNulty Iris, Lee Hang, Mizuno Kyoichi, Jang Ik-Kyung
Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 800, Boston, MA, 02114, USA.
Cardiovascular Center, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamakari, Inzai, Chiba, 270-1694, Japan.
J Thromb Thrombolysis. 2021 Jan;51(1):143-150. doi: 10.1007/s11239-020-02159-8.
As the degree of luminal narrowing increases, shear stress increases, and high shear stress is known to activate platelets. However, the relationship between the degree of luminal narrowing and the composition of thrombus in patients with plaque erosion has not been studied. A total of 148 patients with plaque erosion and thrombus detected by optical coherence tomography were divided into tertiles based on the minimum lumen area (MLA) at the culprit lesion. Thrombus was categorized as platelet-rich or fibrin-rich. Among 148 patients, 50 (34%) were in the mild stenosis group, 49 (33%) were in the moderate stenosis group, and 49 (33%) were in the severe stenosis group. The composition of thrombus was significantly different among the 3 groups (prevalence of platelet-rich thrombus was 60% in the mild stenosis group; 78% in the moderate stenosis group; and 84% in the severe stenosis group; P = 0.021). The pattern of fibrin-rich thrombus showed the opposite: 40%, 22%, and 16%, respectively. In the multivariate analysis, current smoking was independently associated with fibrin-rich thrombus (odds ratio [OR] 2.364 [95% CI 1.004-5.567], P = 0.049). This study demonstrated that platelet-rich thrombus was the predominant type of thrombus in plaque erosion. The prevalence of fibrin-rich thrombus was highest in the mild stenosis group.
随着管腔狭窄程度增加，剪切应力升高，而高剪切应力已知可激活血小板。然而，斑块侵蚀患者的管腔狭窄程度与血栓成分之间的关系尚未得到研究。共有148例经光学相干断层扫描检测出斑块侵蚀和血栓的患者，根据罪犯病变处的最小管腔面积（MLA）分为三分位数组。血栓分为富含血小板型或富含纤维蛋白型。在148例患者中，50例（34%）属于轻度狭窄组，49例（33%）属于中度狭窄组，49例（33%）属于重度狭窄组。三组之间血栓成分存在显著差异（轻度狭窄组富含血小板血栓的患病率为60%；中度狭窄组为78%；重度狭窄组为84%；P = 0.021）。富含纤维蛋白血栓的模式则相反：分别为40%、22%和16%。在多变量分析中，当前吸烟与富含纤维蛋白血栓独立相关（比值比[OR] 2.364 [95% CI 1.004 - 5.567]，P = 0.049）。本研究表明，富含血小板血栓是斑块侵蚀中血栓的主要类型。富含纤维蛋白血栓的患病率在轻度狭窄组中最高。
