Chaudhary Gaurav, Gupta Basant, Roy Shubhajeet, Chandra Sharad, Sharma Akhil, Pradhan Akshyaya, Bhandari Monika, Vishwakarma Pravesh, Sethi Rishi, Dwivedi Sudhanshu Kumar, Baliyan Vinit, Sharma Prachi, Jaiswal Vikash, Singh Abhishek, Shukla Ayush, Shrestha Sajina, Gimelli Alessia
Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India.
King George Medical University, Lucknow, Uttar Pradesh, India.
Eur Heart J Imaging Methods Pract. 2024 May 21;2(1):qyae046. doi: 10.1093/ehjimp/qyae046. eCollection 2024 Jan.
Underlying mechanisms responsible for acute coronary syndrome (ACS) in young patients compared with older counterparts are yet to be explored with optical coherence tomography (OCT). This study aims to explore underlying mechanisms of ACS in ≤35- (very young) and >35-year-old (older counterparts) ACS patients using OCT.
This was a prospective, single-centre, investigational study. Patients were divided into groups according to age (≤35 and >35 years) and further subdivided according to the underlying mechanism i.e. plaque rupture (PR) and plaque erosion (PE). A total of 93 patients were analysed. Thin-cap fibroatheroma (TCFA) was significantly higher among older counterparts than very young patients for both PR (80.0% vs. 31.8%, = 0.002) and PE (66.7% vs. 6.3%, < 0.001) groups. Microchannels were also significantly more prevalent among older than very young patients for both PR (65.0% vs. 18.2%, = 0.004) and PE groups (55.6% vs.12.5%, = 0.013). Macrophages were significantly higher in older than very young patients for both PR (25.0% vs. 0%, = 0.018) and PE (44.4% vs. 0%, = 0.003) groups. In contrast, fibrous cap thickness was greater in very young than older patients for both PR (105.71 ± 48.02 vs. 58.00 ± 15.76 m, < 0.001) and PE (126.67 ± 48.22 vs. 54.38 ± 24.21 m, < 0.001) groups. Intimal thickness was greater in older than very young patients for both PR (728.00 ± 313.92 vs. 342.27 ± 142.02 m, < 0.001) and PE (672.78 ± 334.57 vs. 295.00 ± 99.60 m, < 0.001) groups.
Frequency of TCFA, microchannels, macrophages, and intimal thickness was significantly higher in older ACS patients compared with very young patients. However, fibrous cap thickness was significantly greater in very young ACS patients compared with older patients.
与老年急性冠状动脉综合征（ACS）患者相比，年轻患者发生ACS的潜在机制尚未通过光学相干断层扫描（OCT）进行探索。本研究旨在使用OCT探索年龄≤35岁（非常年轻）和>35岁（老年对照）的ACS患者发生ACS的潜在机制。
这是一项前瞻性、单中心的研究。患者根据年龄（≤35岁和>35岁）分组，并根据潜在机制即斑块破裂（PR）和斑块侵蚀（PE）进一步细分。共分析了93例患者。在PR组（80.0%对31.8%，P = 0.002）和PE组（66.7%对6.3%，P < 0.001）中，老年对照患者的薄帽纤维粥样斑块（TCFA）显著高于非常年轻的患者。在PR组（65.0%对18.2%，P = 0.004）和PE组（55.6%对12.5%，P = 0.013）中，微通道在老年患者中也显著比非常年轻的患者更普遍。在PR组（25.0%对0%，P = 0.018）和PE组（44.4%对0%，P = 0.003）中，老年患者的巨噬细胞显著高于非常年轻的患者。相比之下，在PR组（105.71±48.02对58.00±15.76μm，P < 0.001）和PE组（126.67±48.22对54.38±24.21μm，P < 0.001）中，非常年轻患者的纤维帽厚度大于老年患者。在PR组（728.00±313.92对342.27±142.02μm，P < 0.001）和PE组（672.78±334.57对295.00±99.60μm，P < 0.001）中，老年患者的内膜厚度大于非常年轻的患者。
与非常年轻的患者相比，老年ACS患者的TCFA、微通道、巨噬细胞频率和内膜厚度显著更高。然而，与老年患者相比，非常年轻的ACS患者的纤维帽厚度显著更大。
