无血栓的严重狭窄：它是急性冠脉综合征的第三常见形态吗？
Significant Stenosis Without Thrombus: Is It the Third Most Common Morphology of Acute Coronary Syndrome?
作者信息
Mori Hiroyoshi, Yamamoto Myong Hwa, Mizukami Takuya, Kobayashi Nobuaki, Wakabayashi Kohei, Kondo Seita, Sekimoto Teruo, Sambe Takehiko, Yasuhara Sakiko, Sugiyama Tomoyo, Kakuta Tsunekazu, Mitomo Satoru, Nakamura Sunao, Takano Masamichi, Yonetsu Taishi, Dohi Tomotaka, Yamashita Jun, Yamaguchi Junichi, Kimura Shigeki, Higuma Takumi, Natsumeda Makoto, Ikari Yuji, Suwa Satoru, Suzuki Hiroshi, Shinke Toshiro
机构信息
Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Kanagawa, Japan.
Clinical Research Institute for Clinical Pharmacology & Therapeutics, Showa University, Tokyo, Japan.
出版信息
CJC Open. 2025 Jan 30;7(5):641-648. doi: 10.1016/j.cjco.2025.01.019. eCollection 2025 May.
BACKGROUND
Significant stenosis without thrombus (SSWT) is sometimes observed in patients with acute coronary syndrome (ACS). However, its incidence and clinical features remains unclear.
METHOD
This substudy of the TACTICS registry included patients with ACS (n = 702) undergoing emergency percutaneous coronary intervention using optical coherence tomography. Using this registry data, we compared the clinical features of SSWT in patients with ACS. Major adverse cardiac events were defined as cardiac death, nonfatal myocardial infarction, heart failure, or ischemia-driven revascularization at 1 year.
RESULTS
Plaque rupture (PR; n = 411, 59.1%) and plaque erosion (PE; n = 178, 25.6%) were the 2 major morphologies, followed by SSWT (n = 64, 9.1%) and calcified nodule (CN; n = 28, 4.0%). Patients with SSWT were slightly older than those with PR and PE, but younger than those with CN. In the SSWT, non-ST elevation myocardial infarction was the main type of ACS, followed by unstable angina and ST-elevation myocardial infarction (63%, 22%, and 15%, respectively). Lesions were less complex with a lower proportion of type B2 or C, shorter procedure time, lower proportion of multivessel disease, and lower syntax score, which led to a lower incidence of major adverse cardiac events.
CONCLUSION
SSWT was the third most common morphology of ACS, with clinical features different from those of PR, PE, and CN.
背景
急性冠状动脉综合征（ACS）患者有时会出现无血栓的严重狭窄（SSWT）。然而，其发病率和临床特征仍不清楚。
方法
本TACTICS注册研究的子研究纳入了702例接受光学相干断层扫描急诊经皮冠状动脉介入治疗的ACS患者。利用该注册研究数据，我们比较了ACS患者中SSWT的临床特征。主要不良心脏事件定义为1年内的心脏死亡、非致死性心肌梗死、心力衰竭或缺血驱动的血运重建。
结果
斑块破裂（PR；411例，59.1%）和斑块侵蚀（PE；178例，25.6%）是两种主要形态，其次是SSWT（64例，9.1%）和钙化结节（CN；28例，4.0%）。SSWT患者比PR和PE患者稍年长，但比CN患者年轻。在SSWT中，非ST段抬高型心肌梗死是ACS的主要类型，其次是不稳定型心绞痛和ST段抬高型心肌梗死（分别为63%、22%和15%）。病变复杂性较低，B2或C型比例较低，手术时间较短，多支血管病变比例较低，Syntax评分较低，导致主要不良心脏事件发生率较低。
结论
SSWT是ACS的第三大常见形态，其临床特征与PR、PE和CN不同。
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