Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, Harbin, 150086, China.
Int J Cardiovasc Imaging. 2021 Feb;37(2):399-409. doi: 10.1007/s10554-020-02021-1. Epub 2020 Sep 28.
Local factors of plaque rupture (e.g. lipid burden) are related to preprocedural thrombolysis in myocardial infarction (TIMI) flow grade during primary percutaneous coronary intervention (PCI). However, the pathological mechanism differs between plaque erosion and rupture. We aimed to identify the factors associated with reduced TIMI flow in plaque erosion. A total of 329 ST-segment elevation myocardial infarction (STEMI) patients with optical coherence tomography (OCT) identified plaque erosion were divided into 2 groups by preprocedural TIMI flow grade [TIMI 0-1 group (n = 219) and TIMI 2-3 group (n = 110)]. Patients in TIMI 0-1 group were older (age > 50 years, 68.5% vs. 51.8%, P = 0.003), and had more diabetes mellitus (18.3% vs. 8.2%, P = 0.015). Plaque erosion with TIMI flow 0-1 was less frequently located in the left anterior descending artery (LAD, 58.4% vs. 72.7%, P = 0.011), but more frequently located in the right coronary artery (RCA, 34.2% vs. 7.3%, P = 0.001) than those with TIMI flow 2-3. TIMI 0-1 group had more lipid plaques (53.9% vs. 41.8%, P = 0.039), macrophage accumulation (59.8% vs. 41.8%, P = 0.002), and calcification (34.2% vs. 21.8%, P = 0.020). In the multivariable analysis, age > 50 years, diabetes mellitus, RCA location, and macrophage accumulation were the independent predictors of reduced TIMI flow grade in STEMI patients with plaque erosion. Systemic factors (older age and diabetes mellitus) and local factors (RCA location and macrophage accumulation) were independently associated with reduced coronary flow in STEMI patients with plaque erosion. CLINICAL TRIAL REGISTRATION : ClinicalTrials.gov NCT03084991 May 17, 2017 (retrospectively registered).
斑块破裂的局部因素（如脂质负担）与原发性经皮冠状动脉介入治疗（PCI）中的心肌梗死溶栓治疗（TIMI）血流分级有关。然而，斑块侵蚀和破裂的病理机制不同。我们旨在确定与斑块侵蚀导致 TIMI 血流减少相关的因素。共纳入 329 例经光学相干断层扫描（OCT）诊断为斑块侵蚀的 ST 段抬高型心肌梗死（STEMI）患者，根据术前 TIMI 血流分级分为 2 组[TIMI 0-1 级组（n=219）和 TIMI 2-3 级组（n=110）]。TIMI 0-1 级组患者年龄较大（年龄>50 岁，68.5% vs. 51.8%，P=0.003），糖尿病（18.3% vs. 8.2%，P=0.015）更多。TIMI 0-1 级的斑块侵蚀血流更常发生在右冠状动脉（RCA，34.2% vs. 7.3%，P=0.001），而不是左前降支（LAD，58.4% vs. 72.7%，P=0.011）。TIMI 0-1 级组的脂质斑块（53.9% vs. 41.8%，P=0.039）、巨噬细胞聚集（59.8% vs. 41.8%，P=0.002）和钙化（34.2% vs. 21.8%，P=0.020）更常见。多变量分析显示，年龄>50 岁、糖尿病、RCA 位置和巨噬细胞聚集是 STEMI 斑块侵蚀患者 TIMI 血流分级降低的独立预测因素。系统性因素（年龄较大和糖尿病）和局部因素（RCA 位置和巨噬细胞聚集）与 STEMI 斑块侵蚀患者的冠状动脉血流减少独立相关。临床试验注册：ClinicalTrials.gov NCT03084991 2017 年 5 月 17 日（回顾性注册）。
