Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan.
Am J Cardiol. 2023 Jun 1;196:52-58. doi: 10.1016/j.amjcard.2023.03.007. Epub 2023 Apr 17.
Compared with plaque rupture, plaque erosion has distinct features, which can be diagnosed only by intravascular optical coherence tomography. Computed tomography angiography (CTA) features of plaque erosion have not been reported. The aim of the present study was to identify the CTA features specific for plaque erosion in patients with non-ST-segment elevation acute coronary syndromes to enable a diagnosis of erosion without invasive procedures. Patients with non-ST-segment elevation acute coronary syndromes who underwent preintervention CTA and optical coherence tomography imaging of culprit lesions were enrolled. Plaque volume and high-risk plaque (HRP) features were assessed by CTA. Among 191 patients, plaque erosion was the underlying mechanism in 89 patients (46.6%) and plaque rupture in 102 patients (53.4%). The total plaque volume (TPV) was lower in plaque erosion than in plaque rupture (133.6 vs 168.8 mm, p = 0.001). Plaque erosion had a lower prevalence of positive remodeling than plaque rupture (75.3% vs 87.3%, p = 0.033). As the number of HRP features decreased, plaque erosion became more prevalent (p = 0.014). In the multivariable logistic regression analysis, lower TPV and less prevalent HRP features were associated with a higher prevalence of plaque erosion. The addition of TPV ≤116 mm and HRP features ≤1 to the known predictors significantly increased the area under the curve of the plaque erosion prediction receiver operator characteristics. Plaque erosion, compared with plaque rupture, had a lower plaque volume and less prevalent HRP features. CTA may be helpful for identifying the underlying pathology of acute coronary syndromes.
与斑块破裂相比，斑块侵蚀具有明显的特征，只能通过血管内光学相干断层成像术来诊断。尚未报道斑块侵蚀的计算机断层血管造影（CTA）特征。本研究旨在确定非 ST 段抬高急性冠状动脉综合征患者中特定于斑块侵蚀的 CTA 特征，以便在无需侵入性操作的情况下进行侵蚀诊断。纳入了接受介入前 CTA 和罪犯病变光学相干断层成像术检查的非 ST 段抬高急性冠状动脉综合征患者。通过 CTA 评估斑块体积和高危斑块（HRP）特征。在 191 例患者中，89 例（46.6%）为斑块侵蚀，102 例（53.4%）为斑块破裂。斑块侵蚀的总斑块体积（TPV）低于斑块破裂（133.6 与 168.8 mm，p = 0.001）。斑块侵蚀的正性重构发生率低于斑块破裂（75.3%与 87.3%，p = 0.033）。随着 HRP 特征数量的减少，斑块侵蚀的发生率更高（p = 0.014）。在多变量逻辑回归分析中，较低的 TPV 和较少的 HRP 特征与斑块侵蚀的发生率较高相关。在已知预测因子中加入 TPV ≤116 mm 和 HRP 特征≤1，可显著提高斑块侵蚀预测接受者操作特征曲线的曲线下面积。与斑块破裂相比，斑块侵蚀的斑块体积较小，高危斑块特征较少。CTA 可能有助于识别急性冠状动脉综合征的潜在病理。
