Kaul Upendra, Sethi Rishi, Roy Sanjeeb, Goel P K, Chouhan Nagendra Singh, Vijayvergiya Rajesh, Narang Manish, Baruah D K, Mathew Rony
Batra Hospital & Medical Research Centre, New Delhi, India.
King George's Medical University, Lucknow, India.
Indian Heart J. 2024 Nov-Dec;76(6):370-375. doi: 10.1016/j.ihj.2024.11.001. Epub 2024 Nov 3.
The prevalence of atherosclerosis and acute coronary syndrome (ACS) is increasing in young Indians (18-50 years of age). However, the characteristics of atherosclerotic plaques in such individuals are poorly understood, presenting distinct challenges for the management of ACS. This study aims to analyze plaque characteristics in young Indian patients with ACS who underwent percutaneous coronary intervention (PCI) using optical coherence tomography (OCT) imaging.
This was a prospective, multicentric, non-interventional study on patients aged 18-50 years presenting with ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction, or unstable angina, and were scheduled to undergo OCT-guided PCI. Major adverse cardiac events (MACE) were assessed post-procedure and at the 6-month and 12-month follow-ups.
The study included 100 ACS patients (mean age = 43.6 ± 5.2 years), with 51% presenting with STEMI. Pre-PCI OCT assessment showed that fibrous plaques (75%) were most common followed by plaques containing macrophages (27%), microchannels (20%), and calcified nodules (14%). In addition, plaque rupture, plaque erosion, and lipid-rich plaques, along with red, white, and mixed thrombi, were observed in 31%, 25%, 24%, 21%, 14%, and 17% (total thrombus occurrence = 52%) of the patients, respectively. At 12 months, the MACE (coronary artery bypass graft) rate was 1%.
Young Indian patients with ACS displayed a range of plaque morphologies identified through pre-PCI OCT. Among these, fibrous plaques were the most prominent type, followed by plaques containing macrophages. Additionally, plaque rupture, plaque erosion, and lipid-rich plaques were also observed in this population.
在年轻的印度人（18至50岁）中，动脉粥样硬化和急性冠状动脉综合征（ACS）的患病率正在上升。然而，这类个体中动脉粥样硬化斑块的特征了解甚少，这给ACS的管理带来了独特挑战。本研究旨在分析接受光学相干断层扫描（OCT）成像的经皮冠状动脉介入治疗（PCI）的年轻印度ACS患者的斑块特征。
这是一项针对18至50岁表现为ST段抬高型心肌梗死（STEMI）、非ST段抬高型心肌梗死或不稳定型心绞痛且计划接受OCT引导下PCI的患者的前瞻性、多中心、非干预性研究。术后以及在6个月和12个月随访时评估主要不良心脏事件（MACE）。
该研究纳入了100例ACS患者（平均年龄 = 43.6 ± 5.2岁），其中51%表现为STEMI。PCI术前OCT评估显示，纤维斑块（75%）最为常见，其次是含有巨噬细胞的斑块（27%）、微通道（20%）和钙化结节（14%）。此外，分别在31%、25%、24%、21%、14%和17%的患者中观察到斑块破裂、斑块侵蚀、富含脂质的斑块以及红色、白色和混合血栓（总血栓发生率 = 52%）。在12个月时，MACE（冠状动脉搭桥术）发生率为1%。
年轻的印度ACS患者表现出一系列通过PCI术前OCT识别的斑块形态。其中，纤维斑块是最突出的类型，其次是含有巨噬细胞的斑块。此外，在这一人群中也观察到了斑块破裂、斑块侵蚀和富含脂质的斑块。
