Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education.
J Atheroscler Thromb. 2022 Jan 1;29(1):126-140. doi: 10.5551/jat.60301. Epub 2021 Jan 15.
Recent studies suggested plaque erosion with noncritical stenosis could be treated distinctly from that with critical stenosis, but their morphological features remained largely unknown. The present study aimed to investigate morphological features of eroded plaques with different lumen stenosis using optical coherence tomography (OCT).
A total of 348 ST-segment elevated myocardial infarction patients with culprit OCT-defined plaque erosion (OCT-erosion) were analyzed. Based on the severity of lumen area stenosis, all patients with OCT-erosions were divided into the following three groups: Group A (area stenosis ＜50%, n=50); Group B (50% ≤ area stenosis ＜75%, n=146); Group C (area stenosis ≥ 75%, n=152).
Compared with patients in Groups A and B, patients in Group C were older (p=0.008) and had higher prevalence of hypertension (p=0.029). Angiographic analysis showed that 72.0% of the eroded plaques in Group A were located in the left anterior descending artery, followed by 67.8% in Group B, and 53.9% in Group C (p=0.039). OCT analysis showed that Group A had the highest prevalence of fibrous plaques (p＜0.001) and nearby bifurcation (p=0.036), but the lowest prevalence of lipid-rich plaques (p＜0.001), macrophage accumulation (p＜0.001), microvessels (p=0.009), cholesterol crystals (p＜0.001), and calcification (p=0.023). Multivariable regression analysis showed fibrous plaque (odds ratio [OR]: 3.014, 95% confidence interval [CI]: 1.932-4.702, p＜0.001) and nearby bifurcation (OR: 1.750, 95% CI: 1.109-2.761, p=0.016) were independently associated with OCT-erosion with an area stenosis of ＜75%.
More than half of OCT-erosions presented with ＜75% area stenosis, having distinct morphological features from those of OCT-erosions with critical stenosis. Fibrous plaque and nearby bifurcation were independently associated with noncritically stenotic OCT-erosion, suggesting that eroded plaques might need individualized treatment.
最近的研究表明，非临界狭窄的斑块侵蚀可以与临界狭窄的斑块侵蚀明显区分开来，但它们的形态特征仍知之甚少。本研究旨在应用光学相干断层扫描（OCT）研究不同管腔狭窄程度的侵蚀斑块的形态特征。
对 348 例 ST 段抬高型心肌梗死患者进行分析，这些患者的罪犯 OCT 定义的斑块侵蚀（OCT-erosion）有明确的管腔狭窄。根据管腔面积狭窄程度，所有 OCT-erosion 患者分为以下三组：A 组（面积狭窄＜50%，n=50）；B 组（50%≤面积狭窄＜75%，n=146）；C 组（面积狭窄≥75%，n=152）。
与 A 组和 B 组患者相比，C 组患者年龄较大（p=0.008），高血压患病率较高（p=0.029）。血管造影分析显示，A 组侵蚀斑块 72.0%位于左前降支，B 组为 67.8%，C 组为 53.9%（p=0.039）。OCT 分析显示，A 组纤维斑块的患病率最高（p＜0.001），紧邻分叉处（p=0.036），但富含脂质斑块（p＜0.001）、巨噬细胞聚集（p＜0.001）、微血管（p=0.009）、胆固醇结晶（p＜0.001）和钙化（p=0.023）的患病率最低。多变量回归分析显示，纤维斑块（比值比[OR]：3.014，95%置信区间[CI]：1.932-4.702，p＜0.001）和紧邻分叉（OR：1.750，95%CI：1.109-2.761，p=0.016）与管腔狭窄＜75%的 OCT-erosion 独立相关。
超过一半的 OCT-erosion 患者表现为＜75%的管腔狭窄，其形态特征与临界狭窄的 OCT-erosion 明显不同。纤维斑块和紧邻分叉与非临界狭窄的 OCT-erosion 独立相关，提示侵蚀斑块可能需要个体化治疗。
