Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum Università di Bologna, Bologna.
CLI Foundation, Rome.
J Cardiovasc Med (Hagerstown). 2020 Nov;21(11):860-865. doi: 10.2459/JCM.0000000000001015.
To investigate in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) the prevalence and the features of optical coherence tomography (OCT)-detected macrophages accumulation in culprit plaques as compared with nonculprit plaques (NCP).
The study is a post-hoc analysis of a prospective study aimed at evaluating the relationship between aortic inflammation as assessed by F-fluorodeoxyglucose-PET and features of coronary plaque vulnerability as assessed by OCT. We enrolled 32 patients with first NSTE-ACS who successfully underwent three-vessel OCT.
The median age was 65 (54-72) years and 27 patients (84%) were men. Culprit plaques were clinically defined. Overall, the rate of lipid plaques and lipid plaques containing macrophages were 6.4 and 4.2 per patient, respectively. Culprit plaques had a smaller minimal luminal area, a higher extension of lipid component and a thinner fibrous cap than NCPs. Macrophages accumulations were more likely found in culprit plaque (84 vs. 61%, P = 0.015) in which they had also a higher circumferential extension. On univariable analysis, macrophages accumulation extension had a higher association with culprit plaques (odds ratio = 4.42; 95% confidence interval; 2.54-9.15, P < 0.001) than the mere presence of macrophages accumulation (odds ratio = 3.36; 95% confidence interval; 1.30-8.66, P = 0.012). Culprit plaques with thrombus had a lower distance between macrophages accumulation and the luminal surface than culprit plaque with no thrombus (0.06 vs. 0.1 mm; P = 0.04).
In patients with NSTE-ACS, macrophages accumulations are more likely present in culprit plaque in which they disclose also a greater extension compared with those observed in NCP. The distance between macrophages accumulation and the luminal surface is lower in thrombotic culprit plaque than that in nonthrombotic culprit plaque.
在非 ST 段抬高型急性冠状动脉综合征（NSTE-ACS）患者中，与非罪犯斑块（NCP）相比，光学相干断层扫描（OCT）检测到的罪犯斑块中巨噬细胞积累的患病率和特征。
本研究是一项旨在评估主动脉炎症（通过 F-氟脱氧葡萄糖-PET 评估）与 OCT 评估的斑块易损性特征之间关系的前瞻性研究的事后分析。我们纳入了 32 名首次 NSTE-ACS 并成功接受三血管 OCT 的患者。
中位年龄为 65（54-72）岁，27 名患者（84%）为男性。罪犯斑块通过临床定义。总体而言，每位患者的脂质斑块和含巨噬细胞的脂质斑块的发生率分别为 6.4 和 4.2。罪犯斑块的最小管腔面积较小，脂质成分的延伸较大，纤维帽较薄。巨噬细胞积累更可能发生在罪犯斑块（84%比 61%，P=0.015）中，其周向延伸也更高。单变量分析显示，巨噬细胞积累的扩展与罪犯斑块的关联更高（优势比=4.42；95%置信区间；2.54-9.15，P<0.001），而不仅仅是巨噬细胞积累的存在（优势比=3.36；95%置信区间；1.30-8.66，P=0.012）。有血栓的罪犯斑块中，巨噬细胞积累与管腔表面之间的距离小于无血栓的罪犯斑块（0.06 比 0.1mm；P=0.04）。
在 NSTE-ACS 患者中，巨噬细胞积累更可能存在于罪犯斑块中，与在 NCP 中观察到的相比，它们的扩展更大。血栓形成的罪犯斑块中巨噬细胞积累与管腔表面之间的距离小于非血栓形成的罪犯斑块。
