Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China; Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China.
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Int J Cardiol. 2022 Jul 1;358:1-7. doi: 10.1016/j.ijcard.2022.04.072. Epub 2022 Apr 29.
Plaque rupture occurs when the structural stress inside plaques exceeds the capacity of the overlying fibrous cap. Plaque structural stress has been acknowledged as an index to evaluate the risk of plaque rupture. However, impacting factors associated with the level of plaque structural stress in ST-segment elevated myocardial infarction patients with ruptured plaques remain unknown.
Based on optical coherence tomography, we analyzed the plaque characteristics and calculated the maximal plaque stress of the culprit lesions in 162 patients with plaque rupture by performing finite element analysis. All enrolled patients were divided into two groups according to the level of maximal plaque stress. Cardiovascular risk factors, laboratory findings and clinical outcomes were compared between the two groups.
Hemoglobin A1c (HbA1c) was significantly higher in the high stress group than in the low stress group (7.0% ± 1.8 vs. 6.3% ± 1.2, p = 0.003). The maximal plaque stress of patients with diabetes was significantly higher than that of patients without diabetes (538.7 kPa [346.2-810.6] vs. 425.9 kPa [306.2-571.4], p = 0.006). Moreover, the level of maximal plaque stress was significantly associated with HbA1c (Pearson's correlation coefficient: r = 0.289, P < 0.001). OCT findings showed that the fibrous cap thickness and maximal lipid arc were significantly associated with maximal plaque stress (r = -0.163, p = 0.038; r = 0.194, p = 0.013, respectively).
OCT-based finite-element analysis showed that HbA1c was independently associated with the level of maximal plaque stress in STEMI patients with plaque rupture, thus indicating the importance of glucose control in patients with coronary atherosclerotic disease.
斑块破裂发生于斑块内部的结构应力超过覆盖其上的纤维帽的承受能力时。斑块结构应力已被认为是评估斑块破裂风险的一个指标。然而，在 ST 段抬高型心肌梗死伴斑块破裂患者中，与斑块结构应力水平相关的影响因素尚不清楚。
基于光学相干断层成像术（OCT），我们通过有限元分析，对 162 例斑块破裂患者的罪犯病变的斑块特征进行了分析，并计算了最大斑块应力。所有纳入的患者均根据最大斑块应力水平分为两组。比较两组间心血管危险因素、实验室检查结果和临床结局。
高应力组的糖化血红蛋白（HbA1c）水平显著高于低应力组（7.0%±1.8 比 6.3%±1.2，p=0.003）。糖尿病患者的最大斑块应力显著高于非糖尿病患者（538.7kPa[346.2-810.6]比 425.9kPa[306.2-571.4]，p=0.006）。此外，最大斑块应力水平与 HbA1c 显著相关（Pearson 相关系数：r=0.289，P<0.001）。OCT 检查结果显示，纤维帽厚度和最大脂质弧度与最大斑块应力显著相关（r=-0.163，p=0.038；r=0.194，p=0.013）。
基于 OCT 的有限元分析显示，HbA1c 与 STEMI 伴斑块破裂患者的最大斑块应力水平独立相关，这表明控制血糖在冠状动脉粥样硬化性疾病患者中的重要性。
