急性冠状动脉综合征合并轻度慢性肾脏病患者非罪犯亚临床动脉粥样硬化的动态自然成分和形态变化及其在 5 年随访中的临床意义。

Dynamic natural components and morphological changes in nonculprit subclinical atherosclerosis in patients with acute coronary syndrome and mild chronic kidney disease at the 1-year follow-up and clinical significance at the 5-year follow-up.

机构信息

Department of Cardiology, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing, 210006, China.

Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China.

出版信息

PLoS One. 2024 May 31;19(5):e0302547. doi: 10.1371/journal.pone.0302547. eCollection 2024.

DOI:10.1371/journal.pone.0302547

PMID:38820294

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11142449/

Abstract

INTRODUCTION

The natural outcome of coronary plaque in acute coronary syndrome (ACS) patients with chronic kidney disease (CKD) is unique, which can be analyzed quantitatively by optical flow ratio (OFR) software.

METHODS

A total of 184 ACS patients with at least one nonculprit subclinical atherosclerosis (NSA) detected by optical coherence tomography (OCT) at baseline and 1-year follow-up were divided into non-CKD group (n = 106, estimated glomerular filtration rate (eGFR)> 90 mL/(min×1.73 m2)) and mild CKD group (n = 78, 60≤eGFR<90 mL/(min×1.73 m2)). Changes of normalized total atheroma volume (TAVn) of NSA was the primary endpoint at the 1-year follow-up.

RESULTS

Patients with mild CKD showed more TAVn progression of NSA than non-CKD (p = 0.019) from baseline to the 1-year follow-up, which was mainly due to an increase in calcium TAVn (p<0.001). The morphological change in the maximal calcification thickness (p = 0.026) was higher and the change in the distance from the calcified surface to the contralateral coronary media membrane (ΔC-to-M) at the maximal cross-sectional calcium area was lower (p<0.001) in mild CKD group than in non-CKD group. Mild CKD had more NSA related MACEs at the 5-year follow-up than non-CKD (30.8% vs. 5.8%, p = 0.045).

CONCLUSIONS

Mild CKD patients had more plaque progression of NSA which showed the increase of calcium component with more protrusion into the lumen morphologically at the 1-year follow-up and a higher corresponding incidence of NSA-related MACEs at the 5-year follow-up.

TRIAL REGISTRATION

Clinical Trial registration ClinicalTrials.gov. NCT02140801. https://classic.clinicaltrials.gov/ct2/show/NCT02140801.

摘要

介绍

慢性肾脏病（CKD）患者急性冠脉综合征（ACS）的冠脉斑块的自然转归是独特的，可以通过光流比（OFR）软件进行定量分析。

方法

共有 184 名 ACS 患者在基线和 1 年随访时通过光学相干断层扫描（OCT）检测到至少一处非罪犯亚临床动脉粥样硬化（NSA），分为非 CKD 组（n = 106，估算肾小球滤过率（eGFR）>90 mL/（min×1.73 m2））和轻度 CKD 组（n = 78，60≤eGFR<90 mL/（min×1.73 m2））。NSA 的归一化总动脉粥样硬化体积（TAVn）变化是 1 年随访的主要终点。

结果

与非 CKD 相比，轻度 CKD 患者 NSA 的 TAVn 从基线到 1 年随访期进展更多（p = 0.019），主要是由于钙 TAVn 的增加（p<0.001）。最大钙化厚度的形态变化（p = 0.026）更高，在最大钙化面积的钙化表面与对侧冠脉中膜膜之间的距离（ΔC-to-M）的变化更低（p<0.001），在轻度 CKD 组比非 CKD 组。在 5 年随访时，轻度 CKD 组 NSA 相关的不良心脑血管事件（MACEs）更多（30.8% vs. 5.8%，p = 0.045）。