Yi Boling, He Luping, Zhang Dirui, Zeng Ming, Zhao Chen, Meng Wei, Qin Yuhan, Weng Ziqian, Xu Yishuo, Liu Minghao, Chen Xi, Shao Shuangtong, Sun Qianhui, Wang Wentao, Li Man, Lv Yin, Luo Xing, Bai Xiaoxuan, Weng Xiuzhu, Johnson Jason L, Johnson Thomas, Guagliumi Giulio, Hu Sining, Yu Bo, Jia Haibo
State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Department of Cardiology of the Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China.
Bristol Heart Institute, Translational Health Sciences, University of Bristol, Upper Maudlin Street, Bristol, BS2 8HW, UK.
Atherosclerosis. 2025 Feb;401:119092. doi: 10.1016/j.atherosclerosis.2024.119092. Epub 2025 Jan 13.
Histologic studies indicated that healed plaque, characterized by a multilayered pattern, is indicative of prior atherothrombosis and subsequent healing. However, longitudinal in vivo data on healed plaque formation in non-culprit plaques are limited. This study aimed to investigate serial changes and clinical significance of new layered pattern formation in non-culprit plaques in patients with acute coronary syndromes (ACS) using serial optical coherence tomography (OCT) imaging.
ACS patients who underwent two OCTs at baseline and 1-year follow-up were included. Serial changes in morphologic characteristics of non-culprit plaques were evaluated. New layered pattern was defined as a new signal-rich layer on the plaque surface at follow-up that was not present at baseline.
Among 553 non-culprit plaques observed in 222 patients, 82 (14.8 %) exhibited a new layered pattern at follow-up. Thin-cap fibroatheroma, macrophage, and thrombus were identified as independent predictors of the new layered pattern. Plaques with new layered pattern formation showed a greater significant reduction in luminal area and lipid content, as well as a greater increase in fibrous cap thickness compared to those without. The incidence of 6-year non-culprit-related major adverse cardiac events was higher in patients with new layered pattern than in those without (25.4 % vs. 10.8 %, p = 0.011), mainly due to clinically driven coronary revascularization.
Plaque destabilization and subsequent healing frequently occur in non-culprit plaques after ACS. The formation of a new layered pattern may contribute to temporary plaque stabilization, but results in luminal stenosis and worse clinical outcomes.
组织学研究表明，以多层模式为特征的愈合斑块提示既往存在动脉粥样硬化血栓形成及随后的愈合过程。然而，关于非罪犯斑块中愈合斑块形成的纵向体内数据有限。本研究旨在利用系列光学相干断层扫描（OCT）成像，探讨急性冠状动脉综合征（ACS）患者非罪犯斑块中新分层模式形成的系列变化及其临床意义。
纳入在基线和1年随访时接受两次OCT检查的ACS患者。评估非罪犯斑块形态学特征的系列变化。新分层模式定义为随访时斑块表面出现的新的富含信号层，而基线时不存在。
在222例患者中观察到的553个非罪犯斑块中，82个（14.8%）在随访时出现新分层模式。薄帽纤维粥样斑块、巨噬细胞和血栓被确定为新分层模式的独立预测因素。与未形成新分层模式的斑块相比，形成新分层模式的斑块管腔面积和脂质含量显著降低，纤维帽厚度增加更明显。新分层模式患者6年非罪犯相关主要不良心脏事件的发生率高于无新分层模式的患者（25.4%对10.8%，p = 0.011），主要是由于临床驱动的冠状动脉血运重建。
ACS后非罪犯斑块中经常发生斑块不稳定及随后的愈合。新分层模式的形成可能有助于斑块的暂时稳定，但会导致管腔狭窄和更差的临床结局。
