Sato Takanori, Saito Yuichi, Kitahara Hideki, Kobayashi Yoshio
Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan.
Life (Basel). 2023 Feb 24;13(3):630. doi: 10.3390/life13030630.
The GRACE risk score is established to predict thrombotic events in patients with acute coronary syndrome (ACS). Although thrombotic events including myocardial infarction after ACS are mainly attributable to vulnerable plaque formation, whether the GRACE score correlates with coronary lipid-rich plaque is unclear. A total of 54 patients with ACS undergoing primary percutaneous coronary intervention under near-infrared spectroscopy intravascular ultrasound (NIRS-IVUS) guidance were included in a prospective manner. Patients were divided into two groups according to the median of the GRACE risk score. Coronary lipid plaques in the target vessel were assessed by NIRS-IVUS with lipid core burden index (LCBI) and a maximum LCBI in 4 mm (maxLCBI). The receiver operating characteristics (ROC) curve analysis was performed based on the major adverse cardiovascular events as an exploratory analysis. The GRACE risk score was significantly and positively correlated with LCBI ( = 0.31, = 0.03) and maxLCBI ( = 0.38, = 0.006). LCBI (111.7 ± 85.7 vs. 169.0 ± 83.5, = 0.02) and maxLCBI (428.5 ± 227.1 vs. 600.6 ± 227.7, = 0.009) in the target vessel were significantly higher in the high GRACE risk score group than their counterpart. In the ROC curve analysis, LCBI and maxLCBI were predictive for clinical events. In conclusion, the higher GRACE risk score may serve as a discriminator of risk comprising more lipid-rich plaques as an underlying mechanism of an increased risk of thrombotic events after ACS. In patients with ACS, the higher GRACE risk score was significantly and modestly associated with greater coronary lipid plaques in the target vessel.
全球急性冠状动脉事件注册（GRACE）风险评分用于预测急性冠状动脉综合征（ACS）患者的血栓形成事件。尽管ACS后的血栓形成事件（包括心肌梗死）主要归因于易损斑块的形成，但GRACE评分与冠状动脉富含脂质斑块之间的相关性尚不清楚。本研究前瞻性纳入了54例在近红外光谱血管内超声（NIRS-IVUS）引导下接受直接经皮冠状动脉介入治疗的ACS患者。根据GRACE风险评分的中位数将患者分为两组。通过NIRS-IVUS采用脂质核心负荷指数（LCBI）和4毫米最大LCBI（maxLCBI）评估靶血管中的冠状动脉脂质斑块。基于主要不良心血管事件进行受试者操作特征（ROC）曲线分析作为探索性分析。GRACE风险评分与LCBI（r = 0.31，P = 0.03）和maxLCBI（r = 0.38，P = 0.006）显著正相关。高GRACE风险评分组靶血管中的LCBI（111.7±85.7 vs. 169.0±83.5，P = 0.02）和maxLCBI（428.5±227.1 vs. 600.6±227.7，P = 0.009）显著高于低GRACE风险评分组。在ROC曲线分析中，LCBI和maxLCBI可预测临床事件。总之，较高的GRACE风险评分可能作为一种风险判别指标，提示存在更多富含脂质的斑块，这是ACS后血栓形成事件风险增加的潜在机制。在ACS患者中，较高的GRACE风险评分与靶血管中更大的冠状动脉脂质斑块显著且适度相关。
