冠状动脉造影识别急性心肌梗死罪犯斑块类型价值的研究  

The value of coronary angiography in identifying pathological types of culprit plaque in patients with acute myocardial infarction

作　　者：刘臣[1] 周鹏[1] 谭宇[1] 李健楠[1] 盛兆雪 周金英[1] 陈润真 陈艺 赵汉军[1] 宋莉[1] 颜红兵[1] LIU Chen;ZHOU Peng;TAN Yu;LI Jian-nan;SHENG Zhao-xue;ZHOUJin-ying;CHEN Run-zhen;CHEN Yi;ZHAO Han-jun;SONG Li;YAN Hong-bing(State Key Laboratoryof Cardiovascular Disease,National Center for Cardiovascular Diseases,Fuwai Hospital,Chinese Academy ofMedical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]国家心血管病中心北京协和医学院中国医学科学院阜外医院冠心病中心,北京100037

出　　处：《中国介入心脏病学杂志》2019年第5期243-248,共6页Chinese Journal of Interventional Cardiology

基　　金：中国医学科学院医学与健康科技创新工程基金(2016-I2M-1-009)

摘　　要：目的探讨冠状动脉造影对识别急性心肌梗死罪犯斑块病理类型的价值。方法连续入选OCTAMI研究中前223例经光学相干断层成像(OCT)证实罪犯斑块类型的急性ST段抬高型心肌梗死患者的资料,其中斑块破裂130例(斑块破裂组),斑块侵蚀93例(斑块侵蚀组),结合患者临床特征进行比较分析。结果两组患者性别、高血压病、吸烟、高脂血症、陈旧性心肌梗死、缺血性卒中等比较,差异均无统计学意义(均P>0.05)。斑块破裂组患者年龄[(60.16±10.59)岁比(55.19±10.04)岁,P<0.001]、糖尿病比例(33.8%比18.3%,P=0.010)显著高于斑块侵蚀组。冠状动脉造影显示,斑块侵蚀组单支病变明显高于斑块破裂组(57.0%比36.2%,P=0.004),而三支病变(16.1%比31.5%,P=0.004)少于斑块破裂组,分叉病变在两组中差异无统计学意义(31.2%比36.2%,P=0.440)。logistic多因素回归分析显示,冠状动脉造影显示瘤样扩张伴对比剂滞留患者发生斑块破裂的风险是斑块侵蚀组的2.20倍(95%CI 1.25～4.32,P=0.008);糖尿病(OR 1.15,95%CI 1.00～3.86,P=0.031)、病变支数(OR 1.49,95%CI 1.26～3.98,P=0.049)、钙化(OR 1.11,95%CI 1.00～8.76,P=0.050)和术前C反应蛋白水平(OR 1.09,95%CI 1.01～4.90,P=0.043)与斑块破裂的发生独立相关。冠状动脉造影诊断斑块破裂的真阳性率为76.9%,真阴性率为44.1%,与OCT诊断斑块类型的总符合率为63.2%。结论冠状动脉造影有助于判定斑块类型。破裂多见于年龄偏大、合并糖尿病和多支病变患者,瘤样扩张伴对比剂滞留可能是特征性表现,而侵蚀多见于单支病变患者。Objective To evaluate the value of angiography in identifying pathological types of culprit plaques. Methods Two hudred and twenty three cases who were confirmed pathological type of plaque by OCT in the OCTAMI (Optical Coherence Tomography Examination in Acute Myocardial Infarction) study (NCT 03593928) were consecutively enrolled. One hundred and thirty patients were plaque rupture, and 93 patients were plaque erosion. The data were compared and analyzed in combination with the clinical characteristics of patients. Results There were no significant differences in the percentage of male, hypertension, smoking, hyperlipidemia, prior myocardial infarction, and ischemic stroke between the two groups(P>0.05). Compared with the erosion group, the mean age of plaque rupture group was higher [(60.16±10.59)years vs.(55.19±10.04)years,P<0.001],and the prevalence of diabetes(33.8% vs. 18.3%,P=0.010)was higher. Coronary angiography showed that the rate of single-vessel disease in the plaque erosion group was signifi cantly higher than the plaque rupture group(57.0% vs. 36.2%, P=0.004),while the rate of three-vessel disease(16.1% vs. 31.5%,P=0.004)was lower. There was no diff erence in the distribution of bifurcation lesion between the two groups(31.2% vs. 36.2%,P=0.440). Multivariate logistic regression analysis showed that patients with ectasia and contrast-retained had a 2.20-fold(95% CI 1.25–4.32,P=0.008) higher risk of plaque rupture,and diabetes(OR 1.15,95%CI 1.00–3.86, P=0.03),multi-vessel disease(OR 1.49,95%CI 1.26–3.98,P=0.049),calcification (OR 1.11,95%CI 1.00–8.76,P=0.050)and C-reactive protein level before PCI(OR 1.09,95%CI 1.01–4.90,P=0.043)were independently associated with plaque rupture. The true positive rate of coronary angiography in the diagnosis of plaque rupture was 76.9%,the true negative rate was 44.1%,and the total coincidence rate between coronary angiography and OCT was 63.8%. Conclusions Coronary angiography helps determine the type of plaque. Plaque rupture was more common in patient

关 键 词：冠状动脉造影 斑块破裂 斑块侵蚀 光学相干断层成像 

分 类 号：R541.4[医药卫生—心血管疾病]