斑块负荷与斑块易损性的关系：急性冠状动脉综合征与慢性冠状动脉综合征。

Relationship between plaque burden and plaque vulnerability: Acute coronary syndromes versus chronic coronary syndrome.

机构信息

Gill Gray Research Laboratory, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan.

出版信息

J Cardiovasc Comput Tomogr. 2024 Nov-Dec;18(6):559-566. doi: 10.1016/j.jcct.2024.09.002. Epub 2024 Sep 14.

DOI:10.1016/j.jcct.2024.09.002

PMID:39278792

Abstract

BACKGROUND

The relationship between plaque burden and microscopic characterization of plaque features as it pertains to clinical presentation has not been fully investigated. The aim of this study was to compare the relationship between plaque burden and plaque vulnerability in patients with acute coronary syndromes (ACS) versus chronic coronary syndrome (CCS).

METHODS

Patients who underwent both coronary computed tomography angiography (CTA) and optical coherence tomography (OCT) before coronary intervention were enrolled. All plaques were detected in culprit vessels using CTA, and total plaque volume (TPV) and OCT features were assessed at the corresponding sites. All plaques were divided into three groups according to the tertile levels of TPV (low TPV: <96.5 mm, moderate TPV: 96.5-164.7 mm, high TPV: ≥164.8 mm).

RESULTS

A total of 990 plaques were imaged by OCT in 419 patients: 445 plaques in 190 (45.3%) patients with ACS and 545 in 229 (54.7%) with CCS. Macrophage was more prevalent in plaques with greater TPV in patients who presented with ACS but not in those who presented with CCS (low vs. moderate vs. high TPV group: macrophage 57.4% vs. 71.8% vs. 82.4% in ACS; 63.4% vs. 67.8% vs. 66.7% in CCS; interaction P = 0.004). Lipid arc increased as TPV increased, especially in patients who presented with ACS. Conversely, the layer index increased as TPV increased in patients with CCS.

CONCLUSION

Greater plaque burden was closely related to higher levels of plaque vulnerability in ACS and greater volume of layered plaque in CCS.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT04523194.

摘要

背景

斑块负担与斑块特征的微观特征与临床表现之间的关系尚未得到充分研究。本研究旨在比较急性冠脉综合征（ACS）与慢性冠脉综合征（CCS）患者的斑块负担与斑块易损性之间的关系。

方法

纳入了在冠状动脉介入治疗前同时接受冠状动脉计算机断层扫描血管造影（CTA）和光学相干断层扫描（OCT）的患者。使用 CTA 在罪犯血管中检测到所有斑块，并在相应部位评估总斑块体积（TPV）和 OCT 特征。根据 TPV 的三分位水平（低 TPV：<96.5mm、中 TPV：96.5-164.7mm、高 TPV：≥164.8mm）将所有斑块分为三组。

结果

共对 419 例患者的 990 个斑块进行了 OCT 成像：ACS 患者 190 例（45.3%）中有 445 个斑块，CCS 患者 229 例（54.7%）中有 545 个斑块。在 ACS 患者中，TPV 较大的斑块中巨噬细胞更为常见，但在 CCS 患者中并非如此（低 vs. 中 vs. 高 TPV 组：ACS 中巨噬细胞分别为 57.4%、71.8%、82.4%；CCS 中分别为 63.4%、67.8%、66.7%；交互 P=0.004）。脂质弧随 TPV 的增加而增加，尤其是在 ACS 患者中。相反，在 CCS 患者中，随着 TPV 的增加，层指数增加。