冠状动脉疾病患者中，经光学相干断层扫描评估的冠状动脉钙化积分与罪犯斑块易损性之间的关系
Relationship Between Coronary Artery Calcium Score and Vulnerability of Culprit Plaque Assessed by OCT in Patients With Established Coronary Artery Disease.
作者信息
Fujimoto Daichi, Usui Eisuke, Vergallo Rocco, Kinoshita Daisuke, Suzuki Keishi, Niida Takayuki, Covani Marco, McNulty Iris, Lee Hang, Otake Hiromasa, Shite Junya, Ferencik Maros, Dey Damini, Kakuta Tsunekazu, Jang Ik-Kyung
机构信息
Cardiology Division (D.F., D.K., K.S., T.N., M.C., I.M., I.-K.J.), Massachusetts General Hospital, Harvard Medical School, Boston.
Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Japan (E.U., T.K.).
出版信息
Circ Cardiovasc Imaging. 2025 Jan;18(1):e017099. doi: 10.1161/CIRCIMAGING.124.017099. Epub 2024 Dec 20.
BACKGROUND
Coronary artery calcium score (CACS) is widely used for risk stratification. However, in patients with established coronary artery disease, its clinical implication and relationship with plaque vulnerability are unclear. We sought to correlate the CACS and plaque vulnerability assessed by optical coherence tomography.
METHODS
Patients with coronary artery disease who had CACS and optical coherence tomography before percutaneous coronary intervention were included. Patients were divided into 5 groups based on CACS: CACS of 0, 1 to 99, 100 to 399, 400 to 999, and ≥1000. Optical coherence tomography-derived vulnerable features in culprit plaque were compared between the groups.
RESULTS
In 460 patients, the prevalence of lipid-rich plaque, macrophage, and cholesterol crystal significantly differed among the 5 groups, being lowest in the patients with a CACS of 0. The prevalence of thin-cap fibroatheroma tended to be lower in those with a CACS of 0. No significant difference in vulnerable features was observed between the 4 groups with CACS >0. In the 2-group comparison between the group with a CACS of 0 and the other 4 groups combined, the prevalence of lipid-rich plaque (60.5% versus 85.9%; <0.001), macrophage (48.8% versus 74.1%; <0.001), thin-cap fibroatheroma (16.3% versus 35.0%; =0.013), and cholesterol crystal (11.6% versus 32.9%; =0.004) was significantly lower in the patients with CACS of 0. CACS of 0 was independently negatively associated with lipid-rich plaque, macrophage, thin-cap fibroatheroma, and cholesterol crystal after adjustment for patient characteristics.
CONCLUSIONS
Patients with a CACS of 0 have a significantly lower prevalence of vulnerable plaque features compared with those with CACS >0 in patients with established coronary artery disease.
REGISTRATION
URL: https://www.clinicaltrials.gov; Unique identifier: NCT04523194.
背景
冠状动脉钙化积分（CACS）被广泛用于风险分层。然而，在已确诊冠状动脉疾病的患者中，其临床意义以及与斑块易损性的关系尚不清楚。我们试图将CACS与通过光学相干断层扫描评估的斑块易损性进行关联。
方法
纳入在经皮冠状动脉介入治疗前进行了CACS和光学相干断层扫描的冠状动脉疾病患者。根据CACS将患者分为5组：CACS为0、1至99、100至399、400至999以及≥1000。比较各组罪犯斑块中光学相干断层扫描得出的易损特征。
结果
在460例患者中，富含脂质斑块、巨噬细胞和胆固醇结晶的患病率在5组之间存在显著差异，在CACS为0的患者中最低。薄帽纤维粥样瘤的患病率在CACS为0的患者中往往较低。CACS>0的4组之间在易损特征方面未观察到显著差异。在CACS为0的组与其他4组合并的两组比较中，CACS为0的患者中富含脂质斑块（60.5%对85.9%；<0.001）、巨噬细胞（48.8%对74.1%；<0.001）、薄帽纤维粥样瘤（16.3%对35.0%；=0.013）和胆固醇结晶（11.6%对32.9%；=0.004）的患病率显著较低。在对患者特征进行调整后，CACS为0与富含脂质斑块、巨噬细胞、薄帽纤维粥样瘤和胆固醇结晶独立呈负相关。
结论
在已确诊冠状动脉疾病的患者中，与CACS>0的患者相比，CACS为0的患者易损斑块特征的患病率显著更低。
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