Wu Hanzhi, Yin Yanwei, Lei Fangmeng, Ma Xiaoxue, Lu Wenlin, Shen Yanqing, Zhang Lizhu, Liu Xiaoxiao, Hu Wenjing, Ye Xinhe, Yang Chengjian
Department of Cardiology, Wuxi No. 2 People's Hospital, 68 Zhongshan Road, Liangxi District, Wuxi, 214000, China.
Department of Cardiology, Changzhou Traditional Chinese Medicine Hospital, 25 Heping North Road, Tianning District, Changzhou, 213000, China.
Clin Res Cardiol. 2025 Jun;114(6):760-771. doi: 10.1007/s00392-024-02540-0. Epub 2024 Sep 16.
Currently, the influence of metabolic syndrome (Mets) on the plaque characteristics and prognosis of patients with acute coronary syndrome (ACS) is poorly understood. Thus, the study aimed to characterize the pancoronay plaques of ACS patients with Mets using optical coherence tomography (OCT) and to evaluate the cohort's prognosis.
Between February 2015 and September 2020, 745 ACS patients who underwent OCT imaging of the three coronary arteries were included, divided into Mets (n = 252) and non-Mets (n = 493) groups. The major adverse cardiovascular event (MACE) was a composite of cardiac death, non-fatal myocardial infarction (MI), and revascularization.
Compared to the non-Mets group, the Mets group exhibited a higher proportion of females and cases of multivessel disease. In the Mets group, culprit lesions were found to have a greater degree of stenosis, thinner fibrous cap thickness and more thin-cap fibroatheroma (TCFA). Additionally, nonculprit lesions were more likely to exhibit plaque rupture, high-risk plaque characteristics, TCFA, macrophage infiltration, cholesterol crystals, and layered plaque. After a median follow-up of 2 years, 8.3% of patients experienced MACE, a rate that was higher in the Mets group, primarily attributed to non-fatal myocardial infarction and cardiac death. Multivariate analysis showed that Mets (aHR 1.73, p = 0.037), high-risk plaque (aHR 2.63, p < 0.001), age (aHR 1.03, p = 0.020), and left ventricular ejection fraction (aHR 0.96, p = 0.002) were independent predictors of MACE.
The presence of Mets increased the vulnerability of the entire coronary tree and worsened the prognosis for patients with ACS.
目前，代谢综合征（Mets）对急性冠状动脉综合征（ACS）患者斑块特征及预后的影响尚不清楚。因此，本研究旨在利用光学相干断层扫描（OCT）对合并Mets的ACS患者的全冠状动脉斑块进行特征分析，并评估该队列的预后。
2015年2月至2020年9月期间，纳入745例行三支冠状动脉OCT成像的ACS患者，分为Mets组（n = 252）和非Mets组（n = 493）。主要不良心血管事件（MACE）包括心源性死亡、非致死性心肌梗死（MI）和血运重建。
与非Mets组相比，Mets组女性比例和多支血管病变病例比例更高。在Mets组中，罪犯病变的狭窄程度更大、纤维帽厚度更薄且薄帽纤维粥样斑块（TCFA）更多。此外，非罪犯病变更易出现斑块破裂、高危斑块特征、TCFA、巨噬细胞浸润、胆固醇结晶和分层斑块。中位随访2年后，8.3%的患者发生MACE，Mets组发生率更高，主要归因于非致死性心肌梗死和心源性死亡。多因素分析显示，Mets（调整后风险比[aHR] 1.73，p = 0.037）、高危斑块（aHR 2.63，p < 0.001）、年龄（aHR 1.03，p = 0.020）和左心室射血分数（aHR 0.96，p = 0.002）是MACE的独立预测因素。
Mets的存在增加了整个冠状动脉树的易损性，并使ACS患者的预后恶化。
