Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan.
JACC Cardiovasc Imaging. 2021 Aug;14(8):1628-1638. doi: 10.1016/j.jcmg.2020.08.014. Epub 2020 Sep 30.
This study sought to identify morphological predictors of rapid plaque progression.
Two patterns of plaque progression have been described: slow linear progression and rapid step-wise progression. The former pattern will cause stable angina when the narrowing reaches a critical threshold, whereas the latter pattern may lead to acute coronary syndromes or sudden cardiac death.
Patients who underwent optical coherence tomography (OCT) imaging during the index procedure and follow-up angiography with a minimum interval of 6 months were selected. Nonculprit lesions with a diameter stenosis of ≥30% on index angiography were assessed. Lesion progression was defined as a decrease of angiographic minimum lumen diameter ≥0.4 mm at follow-up (mean, 7.1 months). Baseline morphological characteristics of plaques with rapid progression were evaluated by OCT. In a subgroup with follow-up OCT imaging for plaques with rapid progression, morphological changes from baseline to follow-up were assessed.
Among 517 lesions in 248 patients, 50 lesions showed rapid progression. These lesions had a significantly higher prevalence of lipid-rich plaque (76.0% vs. 50.5%, respectively), thin-cap fibroatheroma (TCFA) (20.0% vs. 5.8%, respectively), layered plaque (60.0% vs. 34.0%, respectively), macrophage accumulation (62.0% vs. 42.4%, respectively), microvessel (46.0% vs. 29.1%, respectively), plaque rupture (12.0% vs. 4.7%, respectively), and thrombus (6.0% vs. 1.1%, respectively) at baseline compared with those without rapid progression. Multivariate analysis identified lipid-rich plaque (odds ratio [OR]: 2.17; 95% confidence interval [CI]: 1.02 to 4.62; p = 0.045]), TCFA (OR: 5.85; 95% CI: 2.01 to 17.03; p = 0.001), and layered plaque (OR: 2.19; 95% CI: 1.03 to 4.17; p = 0.040) as predictors of subsequent rapid lesion progression. In a subgroup analysis for plaques with rapid progression, a new layer was detected in 25 of 41 plaques (61.0%) at follow-up.
Lipid-rich plaques, TCFA, and layered plaques were predictors of subsequent rapid plaque progression. A new layer, a signature of previous plaque disruption and healing, was detected in more than half of the lesions with rapid progression at follow-up. (Massachusetts General Hospital Optical Coherence Tomography Registry; NCT01110538).
本研究旨在确定快速斑块进展的形态学预测因子。
已经描述了两种斑块进展模式：缓慢线性进展和快速阶梯式进展。前者模式在狭窄达到临界阈值时会导致稳定型心绞痛，而后者模式可能导致急性冠脉综合征或心源性猝死。
选择在索引程序期间接受光学相干断层扫描（OCT）成像并在至少 6 个月后进行随访血管造影的患者。评估索引血管造影上直径狭窄≥30%的非罪犯病变。病变进展定义为随访时血管造影最小管腔直径减少≥0.4mm（平均随访时间为 7.1 个月）。通过 OCT 评估快速进展斑块的基线形态特征。在快速进展斑块的随访 OCT 成像亚组中，评估从基线到随访的形态变化。
在 248 名患者的 517 个病变中，50 个病变表现出快速进展。这些病变中富含脂质斑块的发生率明显更高（分别为 76.0%和 50.5%），薄帽纤维粥样瘤（TCFA）（分别为 20.0%和 5.8%），分层斑块（分别为 60.0%和 34.0%），巨噬细胞堆积（分别为 62.0%和 42.4%），微血管（分别为 46.0%和 29.1%），斑块破裂（分别为 12.0%和 4.7%）和血栓（分别为 6.0%和 1.1%）在基线时明显高于无快速进展的病变。多变量分析确定富含脂质斑块（比值比[OR]：2.17；95%置信区间[CI]：1.02 至 4.62；p=0.045）、TCFA（OR：5.85；95%CI：2.01 至 17.03；p=0.001）和分层斑块（OR：2.19；95%CI：1.03 至 4.17；p=0.040）是随后快速病变进展的预测因子。在快速进展斑块的亚组分析中，在 41 个斑块中的 25 个（61.0%）在随访时检测到新层。
富含脂质斑块、TCFA 和分层斑块是随后快速斑块进展的预测因子。在随访中，超过一半的快速进展病变检测到新层，这是先前斑块破裂和愈合的特征。（马萨诸塞州总医院光学相干断层扫描登记处；NCT01110538）。
