Pezel Théo, Sideris Georgios, Dillinger Jean-Guillaume, Logeart Damien, Manzo-Silberman Stéphane, Cohen-Solal Alain, Beauvais Florence, Devasenapathy Niveditha, Laissy Jean-Pierre, Henry Patrick
Department of Cardiology, Lariboisiere Hospital, Assistance Publique - Hôpitaux de Paris (APHP), University of Paris, Paris, France.
Department of Radiology, Lariboisiere Hospital, Assistance Publique - Hôpitaux de Paris (APHP), University of Paris, Paris, France.
Front Cardiovasc Med. 2022 Apr 15;9:876730. doi: 10.3389/fcvm.2022.876730. eCollection 2022.
Aside from the culprit plaque, the presence of vulnerable plaques in patients with acute coronary syndrome (ACS) may be associated with future cardiac events. A link between calcification and plaque rupture has been previously described.
To assess whether analysis of the calcium component of coronary plaques using CT angiography, coronary computed tomographic angiography (CCTA) can help to detect additional vulnerable plaques in patients with non-ST elevation myocardial infarction (NSTEMI).
Cross sectional study of consecutive patients referred for NSTEMI from 30 July to 30 August 2018 with CCTA performed before coronary angiography with systematic optical coherence tomography (OCT) analysis of all coronary arteries within 24 h of clinical onset of NSTEMI. Three types of plaques were defined: culprit plaques defined by angiography (vulnerable culprit plaques-VCP) - plaques with a fibrous cap thickness < 65 microns or thrombus in OCT (vulnerable non-culprit plaque-VNCP) - plaques with a fibrous cap thickness ≥ 65 microns in OCT (stable plaque-SP).
A total of 134 calcified plaques were identified in 29 patients (73% male, 59 ± 14 years) with 29(22%) VCP, 28(21%) VNCP and 77(57%) SP. Using CCTA analysis of the calcium component, factors associated with vulnerable plaques were longer calcification length, larger calcification volume, lower calcium mass, higher Agatston score plaque-specific (ASp), presence of spotty calcifications and an intimal position in the wall. In multivariate analysis, ASp, calcification length and spotty calcifications were independently associated to vulnerable plaques. There was no difference between VCP and VNCP.
CCTA analysis of calcium component of the plaque could help to identify additional vulnerable plaques in NSTEMI patients.
除了罪犯斑块外，急性冠状动脉综合征（ACS）患者中易损斑块的存在可能与未来心脏事件相关。钙化与斑块破裂之间的联系此前已有描述。
评估使用CT血管造影（冠状动脉计算机断层扫描血管造影，CCTA）分析冠状动脉斑块的钙成分是否有助于检测非ST段抬高型心肌梗死（NSTEMI）患者中的其他易损斑块。
对2018年7月30日至8月30日因NSTEMI转诊的连续患者进行横断面研究，在冠状动脉造影前进行CCTA，并在NSTEMI临床发病24小时内对所有冠状动脉进行系统光学相干断层扫描（OCT）分析。定义了三种类型的斑块：血管造影定义的罪犯斑块（易损罪犯斑块-VCP）——OCT中纤维帽厚度<65微米或有血栓的斑块；易损非罪犯斑块（VNCP）——OCT中纤维帽厚度≥65微米的斑块；稳定斑块（SP）。
29例患者（73%为男性，59±14岁）共识别出134个钙化斑块，其中29个（22%）为VCP，28个（21%）为VNCP，77个（57%）为SP。使用CCTA对钙成分进行分析，与易损斑块相关的因素包括钙化长度更长、钙化体积更大、钙质量更低、斑块特异性阿加斯顿评分（ASp）更高、存在斑点状钙化以及在血管壁中的内膜位置。多变量分析中，ASp、钙化长度和斑点状钙化与易损斑块独立相关。VCP和VNCP之间无差异。
CCTA对斑块钙成分的分析有助于识别NSTEMI患者中的其他易损斑块。
