ST 段抬高型心肌梗死患者的高清血管内超声罪犯病变斑块特征和血栓分级。
Culprit lesion plaque characterization and thrombus grading by high-definition intravascular ultrasound in patients with ST-segment elevation myocardial infarction.
机构信息
Department of (Interventional) Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands.
出版信息
Catheter Cardiovasc Interv. 2023 Aug;102(2):191-199. doi: 10.1002/ccd.30699. Epub 2023 May 26.
BACKGROUND
Dedicated prospective studies investigating high-definition intravascular ultrasound (HD-IVUS)-guided primary percutaneous coronary intervention (PCI) are lacking. The aim of this study was to qualify and quantify culprit lesion plaque characteristics and thrombus using HD-IVUS in patients presenting with ST-segment elevation myocardial infarction (STEMI).
METHODS
The SPECTRUM study is a prospective, single-center, observational cohort study investigating the impact of HD-IVUS-guided primary PCI in 200 STEMI patients (NCT05007535). The first 100 study patients with a de novo culprit lesion and a per-protocol mandated preintervention pullback directly after vessel wiring were subject to a predefined imaging analysis. Culprit lesion plaque characteristics and different thrombus types were assessed. An IVUS-derived thrombus score, including a 1-point adjudication for a long total thrombus length, long occlusive thrombus length, and large maximum thrombus angle, was developed to differentiate between low (0-1 points) and high (2-3 points) thrombus burden. Optimal cut-off values were obtained using receiver operating characteristic curves.
RESULTS
The mean age was 63.5 (±12.1) years and 69 (69.0%) patients were male. The median culprit lesion length was 33.5 (22.8-38.9) mm. Plaque rupture and convex calcium were appreciated in 48 (48.0%) and 10 (10.0%) patients, respectively. Thrombus was observed in 91 (91.0%) patients (acute thrombus 3.3%; subacute thrombus 100.0%; organized thrombus 22.0%). High IVUS-derived thrombus burden was present in 37/91 (40.7%) patients and was associated with higher rates of impaired final thrombolysis in myocardial infarction flow (grade 0-2) (27.0% vs. 1.9%, p < 0.001).
CONCLUSIONS
HD-IVUS in patients presenting with STEMI allows detailed culprit lesion plaque characterization and thrombus grading that may guide tailored PCI.
背景
目前缺乏专门针对高清血管内超声（HD-IVUS）指导下直接经皮冠状动脉介入治疗（PCI）的前瞻性研究。本研究旨在通过 HD-IVUS 对 ST 段抬高型心肌梗死（STEMI）患者的罪犯病变斑块特征和血栓进行定性和定量分析。
方法
SPECTRUM 研究是一项前瞻性、单中心、观察性队列研究，共纳入 200 例新发罪犯病变且按方案要求在血管置线后直接进行预介入回撤的 STEMI 患者（NCT05007535）。前 100 例研究患者纳入了预设的影像学分析。评估罪犯病变斑块特征和不同类型的血栓。根据 IVUS 衍生的血栓评分，包括对总血栓长度较长、闭塞性血栓长度较长和最大血栓角度较大的 1 分判断，将低（0-1 分）和高（2-3 分）血栓负荷进行区分。通过受试者工作特征曲线获得最佳截断值。
结果
患者平均年龄为 63.5（±12.1）岁，69 例（69.0%）为男性。罪犯病变长度中位数为 33.5（22.8-38.9）mm。48 例（48.0%）患者存在斑块破裂，10 例（10.0%）患者存在凸面钙。91 例（91.0%）患者存在血栓（急性血栓 3.3%；亚急性血栓 100.0%；机化血栓 22.0%）。37/91 例（40.7%）患者存在高 IVUS 衍生的血栓负荷，与最终心肌梗死血流分级（0-2 级）受损率较高相关（27.0%比 1.9%，p<0.001）。
结论
STEMI 患者行 HD-IVUS 检查可对罪犯病变斑块进行详细特征分析和血栓分级，从而指导个体化 PCI。
Zotero 插件