Intravascular ultrasound assessment of ulcerated ruptured plaques - A comparison of culprit and nonculprit lesions of patients with acute coronary syndromes and lesions in patients without acute coronary syndromes

Article

关键词: HUMAN ATHEROSCLEROTIC PLAQUES;    ACUTE MYOCARDIAL-INFARCTION;    ARTERY-DISEASE;    ANGINA-PECTORIS;    ISCHEMIC DEATH;    SUDDEN-DEATH;    IN-VIVO;    PROGRESSION;    THROMBOSIS;    MECHANISMS;   

DOI  :  10.1161/01.CIR.0000097121.95451.39

来源: SCIE

【 摘 要 】

Background-It is not clear why some plaque ruptures lead to acute coronary syndromes (ACS) but others do not. Methods and Results-We analyzed 80 plaque ruptures in 74 patients and compared culprit lesions of ACS patients with nonculprit lesions of ACS patients and lesions of non-ACS patients; both culprit and nonculprit plaque ruptures were studied in 6 of 54 ACS patients. Intravascular ultrasound findings suggesting thrombus were observed more frequently in culprit lesions of ACS patients (n=35) compared with nonculprit lesions of ACS patients (n=19) and lesions of non-ACS patients (n=26): 60% versus 32% versus 8% (P<0.001). At the minimal lumen site, smaller lumen areas (3.3&PLUSMN;1.5 versus 5.4&PLUSMN;2.6 versus 6.1&PLUSMN;2.0 mm(2), P<0.001) and greater area stenosis (61+/-15% versus 50+/-14% versus 46+/-18%, P=0.002) and plaque burden (80+/-8% versus 71+/-8% versus 69+/-10%, P<0.001) were observed in culprit lesions of ACS patients compared with nonculprit lesions of ACS patients and lesions of non-ACS patients. Lesions were longer (18.7&PLUSMN;6.4 versus 154.9&PLUSMN;6.1 versus 12.0&PLUSMN;4.9 mm, P<0.001) and rupture site remodeling indices were greater (1.26+/-0.21 versus 1.24+/-0.21 versus 1.09+/-0.05, P=0.002). Independent predictors of culprit plaque ruptures in ACS patients were smaller minimum lumen areas (P=0.02) and presence of thrombus (P=0.01). Conclusions-Ruptured plaques in culprit lesions of ACS patients have smaller lumens; greater plaque burdens, area stenosis, and remodeling indices; and more thrombus. Plaque rupture itself does not lead to symptoms. The association of plaque rupture with a smaller lumen area and/or thrombus formation causes lumen compromise and leads to symptoms.

【 授权许可】

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