Hosoda Hayato, Kataoka Yu, Nicholls Stephen J, Puri Rishi, Murai Kota, Kitahara Satoshi, Mitsui Kentaro, Sugane Hiroki, Sawada Kenichiro, Iwai Takamasa, Matama Hideo, Honda Satoshi, Takagi Kensuke, Fujino Masashi, Yoneda Shuichi, Otsuka Fumiyuki, Takamisawa Itaru, Nishihira Kensaku, Asaumi Yasuhide, Kawai Kazuya, Noguchi Teruo
Department of Cardiovascular Medicine, Chikamori Hospital, Kochi, India.
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan.
Int J Cardiovasc Imaging. 2023 Oct;39(10):1927-1941. doi: 10.1007/s10554-023-02905-y. Epub 2023 Jun 28.
Calcified atheroma has been viewed conventionally as stable lesion which less likely increases no-reflow phenomenon. Given that lipidic materials triggers the formation of calcification, lipidic materials could exist within calcified lesion, which may cause no-reflow phenomenon after PCI. The REASSURE-NIRS registry (NCT04864171) employed near-infrared spectroscopy and intravascular ultrasound imaging to evaluate maximum 4-mm lipid-core burden index (maxLCBI) at target lesions containing small (maximum calcification arc < 180°: n = 272) and large calcification (maximum calcification arc ≥ 180°: n = 189) in stable CAD patients. The associations of maxLCBI with corrected TIMI frame count (CTFC) and no-reflow phenomenon after PCI were analyzed in patients with target lesions containing small and large calcification, respectively. No-reflow phenomenon occurred in 8.0% of study population. Receiver-operating characteristics curve analyses revealed that optimal cut-off values of maxLCBI for predicting no-reflow phenomenon were 585 at small calcification (AUC = 0.72, p < 0.001) and 679 at large calcification (AUC = 0.76, p = 0.001). Target lesions containing small calcification with maxLCBI ≥ 585 more likely exhibited a greater CTFC (p < 0.001). In those with large calcification, 55.6% of them had maxLCBI ≥ 400 [vs. 56.2% (small calcification), p = 0.82]. Furthermore, a higher CTFC (p < 0.001) was observed in association with maxLCBI ≥ 679 at large calcification. On multivariable analysis, maxLCBI at large calcification still independently predicted no-reflow phenomenon (OR = 1.60, 95%CI = 1.32-1.94, p < 0.001). MaxLCBI at target lesions exhibiting large calcification elevated a risk of no-reflow phenomenon after PCI. Calcified plaque containing lipidic materials is not necessarily stable lesion, but could be active and high-risk one causing no-reflow phenomenon.
钙化动脉粥样硬化传统上被视为稳定病变，不太可能增加无复流现象。鉴于脂质物质会引发钙化形成，脂质物质可能存在于钙化病变中，这可能在经皮冠状动脉介入治疗（PCI）后导致无复流现象。REASSURE-NIRS注册研究（NCT04864171）采用近红外光谱和血管内超声成像来评估稳定型冠心病患者中包含小钙化（最大钙化弧＜180°：n = 272）和大钙化（最大钙化弧≥180°：n = 189）的靶病变处的最大4毫米脂质核心负荷指数（maxLCBI）。分别分析了包含小钙化和大钙化的靶病变患者中maxLCBI与校正的心肌梗死溶栓治疗帧数（CTFC）及PCI后无复流现象的相关性。8.0%的研究人群出现了无复流现象。受试者操作特征曲线分析显示，预测无复流现象时，小钙化处maxLCBI的最佳截断值为585（曲线下面积[AUC]=0.72，p＜0.001），大钙化处为679（AUC = 0.76，p = 0.001）。maxLCBI≥585的包含小钙化的靶病变更可能表现出更高的CTFC（p＜0.001）。在大钙化患者中，55.6%的患者maxLCBI≥400[相比小钙化患者的56.2%，p = 0.82]。此外，在大钙化患者中，观察到maxLCBI≥679与更高的CTFC相关（p＜0.001）。多变量分析显示，大钙化处的maxLCBI仍可独立预测无复流现象（比值比[OR]=1.60，95%置信区间[CI]=1.32 - 1.94，p＜0.001）。表现为大钙化的靶病变处的maxLCBI会增加PCI后无复流现象的风险。含有脂质物质的钙化斑块不一定是稳定病变，而可能是导致无复流现象的活跃且高危病变。
