Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin, China.
Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin, China.
Int J Cardiol. 2022 Oct 1;364:162-168. doi: 10.1016/j.ijcard.2022.06.016. Epub 2022 Jun 12.
Cholesterol crystals (CCs) are regular microstructures found within the necrotic core of atherosclerotic plaques and have been hypothesized to be related to plaque destabilization. We attempted to investigate the potential association between CCs and non-culprit plaque vulnerability in patients with ST-segment elevated myocardial infarction (STEMI) and study morphological features of CCs in ruptured non-culprit plaques.
A total of 261 patients with ST-segment elevation myocardial infarction who underwent 3-vessel optical coherence tomography (OCT) imaging were included. Non-culprit plaques were divided into two groups according to the presence or absence of CCs in the plaque to compare the morphological characteristics of the plaques. The differences in parameters of the non-culprit plaque CCs were explored between ruptured plaques and unruptured plaques.
Totally, 530 non-culprit plaques (29 ruptured plaques and 501 unruptured plaques) were identified by OCT. The incidence of CCs was 21.1%. Compared with non-culprit plaques without CCs, those with CCs had a larger lipid burden. Macrophages (p < 0.001) and spotty calcification (p = 0.002) were more frequently observed in non-culprit plaques with CCs. The frequency of CCs was significantly higher (p = 0.001) and the CCs were larger (p = 0.046) and more superficial (p = 0.005) in ruptured non-culprit plaques than in unruptured non-culprit plaques. The maximum lipid arc and fibrous cap thickness were independent predictors of plaque rupture, but the presence of CCs was not.
Non-culprit plaques with CCs have more vulnerable features. CCs are more frequently found in ruptured non-culprit plaques and larger and more superficial CCs are associated with plaque rupture.
胆固醇结晶（CCs）是动脉粥样硬化斑块坏死核心内的常见微观结构，其与斑块不稳定有关。本研究旨在探讨 ST 段抬高型心肌梗死（STEMI）患者非罪犯斑块内 CCs 与斑块易损性之间的潜在关联，并研究破裂非罪犯斑块内 CCs 的形态学特征。
共纳入 261 例行 3 血管光学相干断层成像（OCT）检查的 STEMI 患者。根据斑块内是否存在 CCs 将非罪犯斑块分为两组，比较两组斑块的形态学特征。比较破裂斑块和未破裂斑块非罪犯斑块 CCs 各参数的差异。
共识别出 530 个非罪犯斑块（29 个破裂斑块和 501 个未破裂斑块）。CCs 的发生率为 21.1%。与无 CCs 的非罪犯斑块相比，CCs 组的脂质负荷更大。CCs 组的巨噬细胞（p<0.001）和斑片状钙化（p=0.002）更为常见。破裂非罪犯斑块中 CCs 的发生率明显更高（p=0.001），CCs 更大（p=0.046）且更表浅（p=0.005）。最大脂质弧和纤维帽厚度是斑块破裂的独立预测因素，但 CCs 的存在不是。
含 CCs 的非罪犯斑块具有更多的易损性特征。破裂非罪犯斑块中 CCs 更为常见，且较大和更表浅的 CCs 与斑块破裂有关。
