Depré C, Wijns W, Robert A M, Renkin J P, Havaux X
Laboratory of Cardiovascular Pathology, University of Louvain Medical School, Brussels, Belgium.
J Am Coll Cardiol. 1997 Sep;30(3):694-702. doi: 10.1016/s0735-1097(97)00213-1.
The aim of this study was to relate the various clinical presentations of acute coronary syndromes to the underlying plaque morphology as assessed from histopathologic analysis of plaque fragments obtained by directional coronary atherectomy (DCA).
Autopsy studies have shown that unstable angina and infarction are related to plaque instability and involve events such as fissure or rupture of the fibrous cap, thrombosis and inflammation. The clinical severity and prognosis of acute coronary syndromes can be estimated by the Braunwald classification of unstable angina. Whether plaque morphology can be related to the Braunwald classification has not been evaluated.
Plaque fragments were obtained by DCA in 75 patients: 38 with unstable angina, 19 with stable angina and 18 with no symptoms after infarction. The presence of fibrous tissue, thrombus, high cellularity, inflammatory cells, atheroma, neovessels and "stellar-shaped" smooth muscle cells was evaluated in 7-micron thick sections by appropriate staining. The patients were classified according to clinical presentation without knowledge of the results of pathologic examination, and a plaque instability score was assigned. The risk of further cardiac events was classified as low, medium or high.
Increasing severity of the score of unstable angina was associated with increasing prevalence of thrombus, high cellularity, atheroma and neovessels. Plaque from patients with unstable angina considered to be at low risk of further events appeared very similar to that of patients with stable angina, whereas the specific morphologic characteristics of plaque instability were more frequently observed as the clinical score and the risk of further events increased. After thrombolyzed infarction, plaque morphology depends on the delay between the acute event and DCA. Within 1 week after infarction, plaque still showed the morphologic characteristics of instability, whereas late DCA provided samples with morphologic features similar to those observed in patients with stable angina.
The morphologic features of plaque fragments vary at different stages of acute coronary disease. The specific features of plaque instability correlate with the clinical scoring system of the Braunwald classification.
本研究旨在将急性冠状动脉综合征的各种临床表现与通过定向冠状动脉斑块旋切术（DCA）获取的斑块碎片组织病理学分析所评估的潜在斑块形态相关联。
尸检研究表明，不稳定型心绞痛和心肌梗死与斑块不稳定有关，涉及纤维帽破裂或撕裂、血栓形成和炎症等事件。急性冠状动脉综合征的临床严重程度和预后可通过Braunwald不稳定型心绞痛分类来估计。斑块形态是否与Braunwald分类相关尚未得到评估。
对75例患者进行DCA获取斑块碎片：38例不稳定型心绞痛患者，19例稳定型心绞痛患者，18例心肌梗死后无症状患者。通过适当染色在7微米厚的切片中评估纤维组织、血栓、高细胞密度、炎症细胞、动脉粥样硬化、新生血管和“星状”平滑肌细胞的存在。在不了解病理检查结果的情况下，根据临床表现对患者进行分类，并赋予斑块不稳定评分。进一步心脏事件的风险分为低、中、高。
不稳定型心绞痛评分的严重程度增加与血栓、高细胞密度、动脉粥样硬化和新生血管的患病率增加相关。被认为进一步事件风险低的不稳定型心绞痛患者的斑块与稳定型心绞痛患者的斑块非常相似，而随着临床评分和进一步事件风险的增加，斑块不稳定的特定形态特征更频繁地被观察到。溶栓后心肌梗死，斑块形态取决于急性事件与DCA之间的时间间隔。心肌梗死后1周内，斑块仍显示不稳定的形态特征，而晚期DCA提供的样本形态特征与稳定型心绞痛患者观察到的相似。
斑块碎片的形态特征在急性冠状动脉疾病的不同阶段有所不同。斑块不稳定的特定特征与Braunwald分类的临床评分系统相关。
