Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan.
Int J Cardiovasc Imaging. 2021 Apr;37(4):1151-1158. doi: 10.1007/s10554-020-02107-w. Epub 2020 Nov 17.
Near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS) studies have demonstrated that lipid core plaque (LCP) is frequently observed in the culprit segment of myocardial infarction (MI). However, little is known about the impact of clinical presentations such as chronic coronary syndrome (CCS) and acute coronary syndrome (ACS) including unstable angina (UA), non ST-segment elevation MI (NSTEMI), and ST-segment elevation MI (STEMI) on LCP. The present prospective single-center registry included a total of 178 patients who underwent percutaneous coronary intervention under NIRS-IVUS guidance. Patients were divided into CCS and ACS groups, and ACS patients were further sub-divided into the 3 groups according to the clinical presentation. The primary endpoint was coronary LCP in the target lesion assessed by NIRS-IVUS with maximal lipid core burden index over any 4 mm segment (maxLCBI). The study population included 124 and 54 patients with CCS and ACS. MaxLCBI in the target lesion was significantly higher in the ACS group than in the CCS group (503 [284-672] vs. 406 [250-557], p = 0.046). Among ACS patients, MaxLCBI in the target lesion was also significantly different in those with UA (n = 18), NSTEMI (n = 21), and STEMI (n = 15) (288 [162-524] vs. 518 [358-745] vs. 646 [394-848], p = 0.021). In conclusion, LCP assessed by NIRS-IVUS, a surrogate of coronary plaque vulnerability, was significantly different according to the clinical presentations such as CCS, UA, NSTEMI, and STEMI.
近红外光谱血管内超声（NIRS-IVUS）研究表明，脂质核心斑块（LCP）在心肌梗死（MI）的罪犯段中经常被观察到。然而，对于临床表型如慢性冠状动脉综合征（CCS）和急性冠状动脉综合征（ACS），包括不稳定型心绞痛（UA）、非 ST 段抬高型心肌梗死（NSTEMI）和 ST 段抬高型心肌梗死（STEMI）对 LCP 的影响知之甚少。本前瞻性单中心注册研究共纳入 178 例接受 NIRS-IVUS 指导下经皮冠状动脉介入治疗的患者。患者分为 CCS 和 ACS 两组，ACS 患者根据临床表现进一步分为三组。主要终点是通过 NIRS-IVUS 评估的目标病变中的冠状动脉 LCP，最大脂质核心负荷指数（maxLCBI）超过任何 4mm 节段。研究人群包括 124 例 CCS 患者和 54 例 ACS 患者。ACS 组目标病变的 maxLCBI 明显高于 CCS 组（503[284-672] vs. 406[250-557]，p=0.046）。在 ACS 患者中，UA（n=18）、NSTEMI（n=21）和 STEMI（n=15）患者的目标病变的 maxLCBI 也有显著差异（288[162-524] vs. 518[358-745] vs. 646[394-848]，p=0.021）。总之，通过 NIRS-IVUS 评估的 LCP 是冠状动脉斑块易损性的替代物，根据 CCS、UA、NSTEMI 和 STEMI 等临床表型有显著差异。
