Girish M P, Gupta Mohit D, Maehara Akiko, Matsumura Mitsuaki, Bansal Ankit, Kunal Shekhar, Batra Vishal, Mohanty Arun, Qamar Arman, Mintz Gary S, Ali Ziad A, Yusuf Jamal
Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India.
Division of Cardiology, Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA.
AsiaIntervention. 2024 Sep 27;10(3):177-185. doi: 10.4244/AIJ-D-24-00013. eCollection 2024 Sep.
The clinical and pathophysiological characteristics of coronary artery disease in very young adults are poorly described.
Using optical coherence tomography (OCT), we compared culprit lesion morphology in very young adult patients (≤35 years) versus older adult patients (>60 years) with ST-segment elevation myocardial infarction (STEMI).
Culprit lesion morphology was classified as plaque rupture, plaque erosion, or calcified nodule. Thrombus age was subclassified into acute (intraluminal thrombus with surface irregularity) or subacute (mostly mural thrombus with a smooth surface).
A total of 61 patients who underwent thrombolysis within 24 hours from symptom onset were included, with 38 (59.7%) subjects ≤35 years and 23 (40.3%) subjects >60 years of age. As an underlying mechanism of STEMI thrombosis, plaque erosion was more common in very young patients (52.6% vs 21.7%; p=0.02) while plaque rupture was more common in elderly patients (65.2% vs 36.8%; p=0.03). Acute or subacute thrombus was identified in 68.9% (42/61) of patients, with red thrombus being more frequent in very young patients. In the entire patient cohort, acute thrombus was more frequent in plaque rupture compared with plaque erosion (62.0% vs 28.0%; p=0.01), whereas subacute thrombus was more common in plaque erosion versus plaque rupture (52.0% vs 10.3%; p=0.0008).
OCT showed that plaque erosion and plaque rupture were the most common underlying STEMI mechanisms in very young patients and older patients, respectively, and that subjects with plaque erosion had greater evidence of subacute thrombus.
关于极年轻成年人冠状动脉疾病的临床和病理生理特征描述较少。
我们使用光学相干断层扫描（OCT）比较了极年轻成年患者（≤35岁）与老年成年患者（>60岁）ST段抬高型心肌梗死（STEMI）罪犯病变的形态。
将罪犯病变形态分为斑块破裂、斑块侵蚀或钙化结节。血栓年龄分为急性（腔内血栓，表面不规则）或亚急性（主要为壁内血栓，表面光滑）。
共纳入61例症状发作后24小时内接受溶栓治疗的患者，其中38例（59.7%）年龄≤35岁，23例（40.3%）年龄>60岁。作为STEMI血栓形成的潜在机制，斑块侵蚀在极年轻患者中更常见（52.6%对21.7%；p = 0.02），而斑块破裂在老年患者中更常见（65.2%对36.8%；p = 0.03）。68.9%（42/61）的患者被鉴定为急性或亚急性血栓，极年轻患者中红色血栓更常见。在整个患者队列中，与斑块侵蚀相比，斑块破裂中急性血栓更常见（62.0%对28.0%；p = 0.01），而与斑块破裂相比，斑块侵蚀中亚急性血栓更常见（52.0%对10.3%；p = 0.0008）。
OCT显示，斑块侵蚀和斑块破裂分别是极年轻患者和老年患者STEMI最常见的潜在机制，且斑块侵蚀患者有更多亚急性血栓的证据。
