Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan.
J Cardiovasc Comput Tomogr. 2024 Nov-Dec;18(6):568-574. doi: 10.1016/j.jcct.2024.09.007. Epub 2024 Sep 24.
Coronary computed tomography angiography (CTA) allows for the assessment of atherosclerotic plaque burden across the entire coronary vasculature. No studies have examined the relationship between the underlying pathology of the culprit lesion and total plaque burden in patients with acute coronary syndromes. The aim of this study was to compare the total plaque burden between patients with plaque rupture versus plaque erosion.
A total of 232 patients who presented with their first non-ST-segment elevation acute coronary syndrome and underwent both CTA and optical coherence tomography imaging before intervention were selected. Quantitative analysis was performed using semi-automated software (Autoplaque version 3.0, Cedars-Sinai Medical Center). An attenuation of <30 Hounsfield units defined low-density non-calcified plaque (LDNCP). All 3 vessels were assessed using the modified 17-segment American Heart Association model for coronary segment classification.
Among 232 patients, 125 (53.9%) had plaque rupture and 107 (46.1%) had plaque erosion. Total plaque burden (48.2 [39.8-54.9] % vs. 44.1 [38.6-50.0] %, P = 0.006), total non-calcified plaque (NCP) burden (46.6 [39.1-53.3] % vs. 43.0 [37.6-49.2] %, P = 0.013), total LDNCP burden (2.3 [1.4-3.0] % vs. 1.7 [1.2-2.6] %, P = 0.016), and total calcified plaque (CP) burden (0.8 [0.1-1.6] % vs. 0.4 [0.0-1.4] %, P = 0.047) were significantly greater in patients with culprit plaque rupture than in those with culprit plaque erosion.
Patients with plaque rupture, compared with those with plaque erosion, had a greater total plaque burden, NCP burden, LDNCP burden, and CP burden.
URL: https://www.
gov; Unique identifier: NCT04523194.
冠状动脉计算机断层血管造影（CTA）可评估整个冠状动脉血管的动脉粥样硬化斑块负担。尚无研究探讨急性冠状动脉综合征患者罪犯病变的潜在病理学与总斑块负担之间的关系。本研究旨在比较斑块破裂与斑块侵蚀患者之间的总斑块负担。
入选 232 例首次出现非 ST 段抬高型急性冠状动脉综合征且在介入治疗前均行 CTA 和光学相干断层成像检查的患者。采用半自动软件（Cedars-Sinai 医疗中心的 Autoplaque 版本 3.0）进行定量分析。将衰减值<30 亨氏单位定义为低密度非钙化斑块（LDNCP）。采用改良的 17 节段美国心脏协会冠状动脉节段分类模型对所有 3 支血管进行评估。
在 232 例患者中，125 例（53.9%）存在斑块破裂，107 例（46.1%）存在斑块侵蚀。总斑块负担（48.2[39.8-54.9]%比 44.1[38.6-50.0]%，P=0.006）、总非钙化斑块（NCP）负担（46.6[39.1-53.3]%比 43.0[37.6-49.2]%，P=0.013）、总 LDNCP 负担（2.3[1.4-3.0]%比 1.7[1.2-2.6]%，P=0.016）和总钙化斑块（CP）负担（0.8[0.1-1.6]%比 0.4[0.0-1.4]%，P=0.047）在斑块破裂的罪犯病变患者中明显高于斑块侵蚀的罪犯病变患者。
与斑块侵蚀患者相比，斑块破裂患者的总斑块负担、NCP 负担、LDNCP 负担和 CP 负担更大。
