Terada Kosei, Kubo Takashi, Khalifa Amir Kh M, Wang Wei-Ting, Fujita Suwako, Madder Ryan D
Department of Cardiovascular Medicine, Wakayama Medical University.
Department of Cardiovascular Medicine, Shingu Municipal Hospital.
J Atheroscler Thromb. 2024 Sep 7. doi: 10.5551/jat.64781.
Healed plaque (HP) is associated with rapid plaque growth and luminal narrowing. Thin-cap fibroatheroma (TCFA) is recognized as a precursor lesion to plaque rupture. The aim of the present study was to compare the lipid size among optical coherence tomography (OCT)-derived HP, TCFA, and thick-cap fibroatheroma (ThCFA) using near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS).
The present study included 173 patients with acute myocardial infarction (AMI) who underwent percutaneous coronary intervention. Non-culprit lesions with angiographically intermediate stenosis were assessed by both OCT and NIRS-IVUS.
The frequency of TCFA, HP, and ThCFA was 35 (20%), 53 (30%), and 85 (49%), respectively. Minimum lumen area was not significantly different between TCFA and HP, but was smaller in TCFA and HP than in ThCFA (4.6 [interquartile range {IQR}: 3.5-6.4] mm vs. 4.3 [3.4-5.3] mm vs. 6.5 [4.8-8.6] mm, P＜0.001). Plaque burden was not significantly different between TCFA and HP, but was larger in TCFA and HP than in ThCFA (72 [IQR: 66-80] % vs. 75 [67-80] % vs. 62 [54-69] %, P＜0.001). Maximum lipid core burden index in 4mm (maxLCBI) was largest in TCFA, followed by HP and ThCFA (493 [IQR: 443-606] vs. 446 [347-520] vs. 231 [161-302], P＜0.001). The frequency of lipid rich plaque with maxLCBI ＞400 was highest in TCFA, followed by HP and ThCFA (89% vs. 60% vs. 7%, P＜0.001).
Based on NIRS-IVUS findings, non-culprit coronary HP in AMI was associated with vulnerable plaque characteristics, but not as much as TCFA.
愈合斑块（HP）与斑块快速生长和管腔狭窄相关。薄帽纤维粥样瘤（TCFA）被认为是斑块破裂的前驱病变。本研究的目的是使用近红外光谱 - 血管内超声（NIRS-IVUS）比较光学相干断层扫描（OCT）衍生的HP、TCFA和厚帽纤维粥样瘤（ThCFA）中的脂质大小。
本研究纳入了173例行经皮冠状动脉介入治疗的急性心肌梗死（AMI）患者。对血管造影显示为中度狭窄的非罪犯病变进行OCT和NIRS-IVUS评估。
TCFA、HP和ThCFA的发生率分别为35例（20%）、53例（30%）和85例（49%）。TCFA和HP之间的最小管腔面积无显著差异，但TCFA和HP中的最小管腔面积小于ThCFA（4.6 [四分位间距{IQR}：3.5 - 6.4] mm对4.3 [3.4 - 5.3] mm对6.5 [4.8 - 8.6] mm，P＜0.001）。TCFA和HP之间的斑块负荷无显著差异，但TCFA和HP中的斑块负荷大于ThCFA（72 [IQR：66 - 80] %对75 [67 - 80] %对62 [54 - 69] %，P＜0.001）。4mm处的最大脂质核心负荷指数（maxLCBI）在TCFA中最大，其次是HP和ThCFA（493 [IQR：443 - 606]对446 [347 - 520]对231 [161 - 302]，P＜0.001）。maxLCBI＞400的富含脂质斑块的频率在TCFA中最高，其次是HP和ThCFA（89%对60%对7%，P＜0.001）。
基于NIRS-IVUS的研究结果，AMI中非罪犯冠状动脉HP与易损斑块特征相关，但程度不如TCFA。
