Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York.
Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York; Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea; Cardiovascular Center, Seoul National University Bundang Hospital, Sungnam, South Korea.
Am J Cardiol. 2021 Nov 1;158:15-22. doi: 10.1016/j.amjcard.2021.07.040. Epub 2021 Aug 29.
Although acute coronary syndrome culprit lesions occur more frequently in the proximal coronary artery, whether the proximal clustering of high-risk plaque is reflected in earlier-stage atherosclerosis remains unclarified. We evaluated the longitudinal distribution of stable atherosclerotic lesions on coronary computed tomography angiography (CCTA) in 1,478 patients (mean age, 61 years; men, 58%) enrolled from a prospective multinational registry of consecutive patients undergoing serial CCTA. Of 3,202 coronary artery lesions identified, 2,140 left lesions were classified (based on the minimal lumen diameter location) into left main (LM, n = 128), proximal (n = 739), and other (n = 1,273), and 1,062 right lesions were classified into proximal (n = 355) and other (n = 707). Plaque volume (PV) was the highest in proximal lesions (median, 26.1 mm), followed by LM (20.6 mm) and other lesions (15.0 mm, p <0.001), for left lesions, and was lager in proximal (25.8 mm) than in other lesions (15.2 mm, p <0.001) for right lesions. On both sides, proximally located lesions tended to have greater necrotic core and fibrofatty components than other lesions (left: LM, 10.6%; proximal, 5.8%; other, 3.4% of the total PV, p <0.001; right: proximal, 8.4%; other 3.1%, p <0.001), with less calcified plaque component (left: LM, 18.3%; proximal, 30.3%; other, 37.7%, p <0.001; right: proximal, 23.3%, other, 36.6%, p <0.001), and tended to progress rapidly (adjusted odds ratios: left: LM, reference; proximal, 0.95, p = 0.803; other, 0.64, p = 0.017; right: proximal, reference; other, 0.52, p <0.001). Proximally located plaques were larger, with more risky composition, and progressed more rapidly.
虽然急性冠状动脉综合征的罪犯病变更常发生在近端冠状动脉，但高危斑块的近端聚集是否反映在早期动脉粥样硬化中仍不清楚。我们评估了前瞻性多国连续冠状动脉计算机断层扫描血管造影（CCTA）登记研究中 1478 例（平均年龄 61 岁；男性占 58%）患者的稳定粥样硬化病变的纵向分布。在确定的 3202 个冠状动脉病变中，2140 个左侧病变（基于最小管腔直径位置）分为左主干（LM，n=128）、近端（n=739）和其他（n=1273），1062 个右侧病变分为近端（n=355）和其他（n=707）。斑块体积（PV）在近端病变中最高（中位数 26.1mm），其次是 LM（20.6mm）和其他病变（15.0mm，p<0.001），对于左侧病变，在右侧病变中，近端病变（25.8mm）大于其他病变（15.2mm，p<0.001）。在两侧，与其他病变相比，位于近端的病变更倾向于具有更大的坏死核心和纤维脂肪成分（左侧：LM，10.6%；近端，5.8%；其他，总 PV 的 3.4%，p<0.001；右侧：近端，8.4%；其他，3.1%，p<0.001），钙化斑块成分较少（左侧：LM，18.3%；近端，30.3%；其他，37.7%，p<0.001；右侧：近端，23.3%；其他，36.6%，p<0.001），并且更倾向于快速进展（调整后的优势比：左侧：LM，参考；近端，0.95，p=0.803；其他，0.64，p=0.017；右侧：近端，参考；其他，0.52，p<0.001）。位于近端的斑块更大，具有更高的风险成分，并且进展更快。
