Hirose Takato, Fujii Kenichi, Hashimoto Kenta, Bando Kazunori, Morishita Shun, Taniichi Masanao, Horitani Keita, Shiojima Ichiro
Division of Cardiology, Department of Medicine II, Kansai Medical University, Hirakata, Osaka, 5731010, Japan.
Cardiovasc Interv Ther. 2025 Jun 6. doi: 10.1007/s12928-025-01146-1.
Since patients with cardiac arrest associated with acute myocardial infarction (MI) may not be successfully resuscitated, the underlying mechanisms of acute MI leading to out-of-hospital cardiac arrest (OHCA) have not been elucidated. This study evaluated whether there are differences in the plaque characteristics of infarct-related lesions between acute MI patients with OHCA and those without OHCA. This study analyzed 604 consecutive patients with a diagnosis of acute MI who underwent intravascular ultrasound (IVUS) evaluation of the infarct-related lesion before coronary intervention. All study patients were divided into two groups based on whether they presented with OHCA. The underlying mechanisms of acute MI were classified into four categories according to pre-interventional angiographic and IVUS images: plaque rupture, plaque erosion, calcified nodule, and embolization. Of the 604 patients diagnosed with acute MI, 69 (11%) suffered from OHCA. The OHCA group had a higher frequency of plaque rupture and calcified nodules than the non-OHCA group. Multivariate logistic regression analysis showed that an infarct-related lesion in the left main artery, the underlying plaque morphology of a calcified nodule, and plaque rupture were significantly associated with OHCA. In patients with acute MI, plaque morphology of infarct-related lesions with plaque rupture or a calcified nodule has a higher risk of leading to OHCA than other morphological types.
由于伴有急性心肌梗死（MI）的心脏骤停患者可能无法成功复苏，导致院外心脏骤停（OHCA）的急性MI的潜在机制尚未阐明。本研究评估了发生OHCA的急性MI患者与未发生OHCA的急性MI患者梗死相关病变的斑块特征是否存在差异。本研究分析了604例连续诊断为急性MI且在冠状动脉介入治疗前接受了梗死相关病变血管内超声（IVUS）评估的患者。所有研究患者根据是否出现OHCA分为两组。根据介入前血管造影和IVUS图像，将急性MI的潜在机制分为四类：斑块破裂、斑块侵蚀、钙化结节和栓塞。在604例诊断为急性MI的患者中，69例（11%）发生了OHCA。OHCA组斑块破裂和钙化结节的发生率高于非OHCA组。多因素logistic回归分析显示，左主干动脉的梗死相关病变、钙化结节的潜在斑块形态和斑块破裂与OHCA显著相关。在急性MI患者中，伴有斑块破裂或钙化结节的梗死相关病变的斑块形态比其他形态类型导致OHCA的风险更高。
