Cardiology Division (H.Y., K.S., D.K., T.N., I.M., I.-K.J.), Massachusetts General Hospital, Harvard Medical School, Boston.
Department of Cardiology, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (T.S., T.K.).
Circ Cardiovasc Imaging. 2023 Mar;16(3):e014959. doi: 10.1161/CIRCIMAGING.122.014959. Epub 2023 Mar 3.
Vascular inflammation plays a key role in atherogenesis and in the development of acute coronary syndromes. Coronary inflammation can be measured by peri-coronary adipose tissue (PCAT) attenuation on computed tomography angiography. We examined the relationships between the level of coronary artery inflammation assessed by PCAT attenuation and coronary plaque characteristics by optical coherence tomography.
A total of 474 patients (198 acute coronary syndromes and 276 stable angina pectoris) who underwent preintervention coronary computed tomography angiography and optical coherence tomography were included. To compare the relationships between the level of coronary artery inflammation and detailed plaque characteristics, we divided the subjects into high (n=244) and low (n=230) PCAT attenuation groups using a threshold value of -70.1 Hounsfield units.
The high PCAT attenuation group, compared with the low PCAT attenuation group, had more males (90.6% versus 69.6%; <0.001), more non-ST-segment elevation myocardial infarction (38.5% versus 25.7%; =0.003), and less stable angina pectoris (51.6% versus 65.2%; =0.003). Aspirin, dual antiplatelet, and statins were less frequently used in the high PCAT attenuation group compared to the low PCAT attenuation group. Patients with high PCAT attenuation, compared with those with low PCAT attenuation, had lower ejection fraction (median 64% versus 65%; =0.014) and lower levels of high-density lipoprotein cholesterol (median 45 versus 48 mg/dL; =0.027). Optical coherence tomography features of plaque vulnerability were significantly more common in patients with high PCAT attenuation, compared to those with low PCAT attenuation, including lipid-rich plaque (87.3% versus 77.8%; =0.006), macrophage (76.2% versus 67.8%; =0.041), microchannels (61.9% versus 48.3%; =0.003), plaque rupture (38.1% versus 23.9%; <0.001), and layered plaque (60.2% versus 50.0%; =0.025).
Optical coherence tomography features of plaque vulnerability were significantly more common in patients with high PCAT attenuation, compared with those with low PCAT attenuation. Vascular inflammation and plaque vulnerability are intimately related in patients with coronary artery disease.
URL: https://www.
gov; Unique identifier: NCT04523194.
血管炎症在动脉粥样硬化形成和急性冠状动脉综合征的发展中起着关键作用。冠状动脉炎症可以通过计算机断层血管造影术（computed tomography angiography，CTA）测量的冠状动脉周围脂肪组织（peri-coronary adipose tissue，PCAT）衰减来评估。我们研究了通过 PCAT 衰减评估的冠状动脉炎症水平与光学相干断层扫描（optical coherence tomography，OCT）所示冠状动脉斑块特征之间的关系。
共纳入 474 例（198 例急性冠状动脉综合征和 276 例稳定型心绞痛）接受冠状动脉 CT 血管造影和 OCT 检查的患者。为了比较冠状动脉炎症水平与详细斑块特征之间的关系，我们使用-70.1 亨氏单位的阈值将患者分为高（n=244）和低（n=230）PCAT 衰减组。
与低 PCAT 衰减组相比，高 PCAT 衰减组的男性比例更高（90.6%比 69.6%；<0.001），非 ST 段抬高型心肌梗死患者更多（38.5%比 25.7%；=0.003），稳定型心绞痛患者更少（51.6%比 65.2%；=0.003）。与低 PCAT 衰减组相比，高 PCAT 衰减组阿司匹林、双联抗血小板和他汀类药物的使用频率更低。与低 PCAT 衰减组相比，高 PCAT 衰减组患者的射血分数更低（中位数 64%比 65%；=0.014），高密度脂蛋白胆固醇水平更低（中位数 45 比 48 mg/dL；=0.027）。与低 PCAT 衰减组相比，高 PCAT 衰减组的斑块易损性 OCT 特征更常见，包括富含脂质的斑块（87.3%比 77.8%；=0.006）、巨噬细胞（76.2%比 67.8%；=0.041）、微通道（61.9%比 48.3%；=0.003）、斑块破裂（38.1%比 23.9%；<0.001）和分层斑块（60.2%比 50.0%；=0.025）。
与低 PCAT 衰减组相比，高 PCAT 衰减组患者的斑块易损性 OCT 特征更常见。在患有冠状动脉疾病的患者中，血管炎症和斑块易损性密切相关。
URL：https://www.
gov；独特标识符：NCT04523194。
