Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Institute of Cardiovascular disease, Madras Medical Mission, Chennai, India.
Int J Cardiol. 2021 Nov 15;343:171-179. doi: 10.1016/j.ijcard.2021.08.048. Epub 2021 Sep 3.
South Asians, and Indians in particular, are known to have a higher incidence of premature atherosclerosis and acute coronary syndromes (ACS) with worse clinical outcomes, compared to populations with different ethnic backgrounds. However, the underlying pathobiology accounting for these differences has not been fully elucidated.
ACS patients who had culprit lesion optical coherence tomography (OCT) imaging were enrolled. Culprit plaque characteristics were evaluated using OCT.
Among 1315 patients, 100 were South Asian, 1009 were East Asian, and 206 were White. South Asian patients were younger (South Asians vs. East Asians vs. Whites: 51.6 ± 13.4 vs. 65.4 ± 11.9 vs. 62.7 ± 11.7; p < 0.001) and more frequently presented with ST-segment elevation myocardial infarction (STEMI) (77.0% vs. 56.4% vs. 35.4%; p < 0.001). On OCT analysis after propensity group matching, plaque erosion was more frequent (57.0% vs. 38.0% vs. 50.0%; p = 0.003), the lipid index was significantly greater (2281.6 [1570.8-3160.6] vs. 1624.3 [940.9-2352.4] vs. 1303.8 [1090.0-1757.7]; p < 0.001), and the prevalence of layered plaque was significantly higher in the South Asian group than in the other two groups (52.0% vs. 30.0% vs. 34.0%; p = 0.003).
Compared to East Asians and Whites, South Asians with ACS were younger and more frequently presented with STEMI. Plaque erosion was the predominant pathology for ACS in South Asians and their culprit lesions had more features of plaque vulnerability.
http://www.clinicaltrials.gov, NCT03479723.
与具有不同种族背景的人群相比，南亚人，尤其是印度人，其动脉粥样硬化和急性冠状动脉综合征（ACS）的发病更早，且临床结局更差。然而，导致这些差异的潜在病理生物学机制尚未完全阐明。
本研究纳入了接受罪犯病变光学相干断层扫描（OCT）成像的 ACS 患者。采用 OCT 评估罪犯斑块特征。
在 1315 例患者中，有 100 例为南亚人，1009 例为东亚人，206 例为白人。南亚患者更年轻（南亚人 vs. 东亚人 vs. 白人：51.6±13.4 岁 vs. 65.4±11.9 岁 vs. 62.7±11.7 岁；p<0.001），且更常出现 ST 段抬高型心肌梗死（STEMI）（77.0% vs. 56.4% vs. 35.4%；p<0.001）。经倾向评分匹配后的 OCT 分析显示，斑块蚀变更为常见（57.0% vs. 38.0% vs. 50.0%；p=0.003），脂质指数显著更大（2281.6[1570.8-3160.6] vs. 1624.3[940.9-2352.4] vs. 1303.8[1090.0-1757.7]；p<0.001），且南亚人群中分层斑块的发生率明显高于其他两组（52.0% vs. 30.0% vs. 34.0%；p=0.003）。
与东亚人和白人相比，患有 ACS 的南亚人更年轻，且更常出现 STEMI。斑块蚀变是南亚 ACS 的主要病理表现，其罪犯病变具有更多的斑块易损性特征。
