ST段抬高型心肌梗死患者罪犯血管大小与斑块特征的相关性
Associations of Culprit Vessel Size and Plaque Characteristics in Patients with ST-Segment Elevation Myocardial Infarction.
作者信息
Li Jiannan, Chen Runzhen, Zhou Jinying, Wang Ying, Zhao Xiaoxiao, Liu Chen, Zhou Peng, Chen Yi, Song Li, Yan Shaodi, Yan Hongbing, Zhao Hanjun
机构信息
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, 100005 Beijing, China.
Fuwai Hospital, Chinese Academy of Medical Sciences, 518057 Shenzhen, Guangdong, China.
出版信息
Rev Cardiovasc Med. 2023 Jun 29;24(7):186. doi: 10.31083/j.rcm2407186. eCollection 2023 Jul.
BACKGROUND
Small vessel disease (SVD) widely exists in patients with acute coronary syndrome. However, the plaque characteristic of SVD has not been investigated.
METHODS
Optical coherence tomography (OCT) of culprit lesion was examined in 576 patients with ST-segment elevation myocardial infarction (STEMI) and finally 404 patients with qualified images were analysed of plaque phenotypes and microstructure. The cohort was divided into three groups according to vessel diameters of culprit lesion which were measured by OCT. Major adverse cardiac events (MACEs) were recorded of each patient and compared among patients with different vessel diameters and plaque phenotypes.
RESULTS
Gender, age and body mass index (BMI) were significantly different among patients with different diameters of culprit vessels (98.4% vs. 85.7% vs.71.4%, 0.001; 40.0 7.0 vs. 54.9 6.6 vs. 68.9 5.8, 0.001; 28.4 4.0 vs. 25.8 2.9 vs. 25.2 3.0, 0.001, respectively). Moreover, patients with diameters of culprit lesion 3 mm presented with more incidence of plaque rupture and macrophage (57.7% vs. 42.1% vs. 46.2%, = 0.015, 55.1% vs. 41.0% vs. 36.9%, = 0.010). Total MACE did not differ among groups of different vessel diameters and plaque phenotypes.
CONCLUSIONS
Vessel size of culprit lesion is significantly associated with plaque phenotype in patients with STEMI. However, patients with different diameters and plaque phenotypes showed no significant difference of clinical outcomes.
CLINICAL TRIAL REGISTRATION
NCT03593928.
背景
小血管疾病（SVD）广泛存在于急性冠状动脉综合征患者中。然而，SVD的斑块特征尚未得到研究。
方法
对576例ST段抬高型心肌梗死（STEMI）患者的罪犯病变进行光学相干断层扫描（OCT）检查，最终对404例图像合格的患者分析斑块表型和微观结构。根据OCT测量的罪犯病变血管直径将队列分为三组。记录每位患者的主要不良心脏事件（MACE），并在不同血管直径和斑块表型的患者之间进行比较。
结果
不同罪犯血管直径的患者在性别、年龄和体重指数（BMI）方面存在显著差异（分别为98.4%对85.7%对71.4%，P<0.001；40.0±7.0对54.9±6.6对68.9±5.8，P<0.001；28.4±4.0对25.8±2.9对25.2±3.0，P<0.001）。此外，罪犯病变直径≤3mm的患者斑块破裂和巨噬细胞的发生率更高（分别为57.7%对42.1%对46.2%，P=0.015；55.1%对41.0%对36.9%，P=0.010）。不同血管直径和斑块表型的组间总MACE无差异。
结论
STEMI患者罪犯病变的血管大小与斑块表型显著相关。然而，不同直径和斑块表型的患者临床结局无显著差异。
临床试验注册
NCT03593928。
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