用光学相干断层扫描比较两种类型冠心病受累血管病变的特点

Assessment of culprit lesion in acute myocardial infarction and stable angina pectoris by optical coherence tomography

目的:用光学相干断层扫描(OCT)比较急性心肌梗死(AMI)及稳定型心绞痛(SAP)受累血管病变的特征。方法:选取140例接受冠脉造影(CAG)及OCT检查的患者,其中61例AMI患者,79例SAP患者。分析患者的临床相关信息,用OCT评价受累血管的病变特点。结果:纤维帽厚度在AMI组比SAP组薄[(45±13)μm vs.(80±39)μm,P<0.01)];薄纤维帽富含脂质的斑块更多见于AMI组(56%vs.25%,P<0.01);血栓更多见于AMI组(52%vs.5%,P<0.01);斑块破裂的发生率分别是(67%vs.25%),P<0.01),溃疡和夹层等较重的斑块破裂均发生AMI组;4个象限的富含脂质斑块更易出现在AMI组;钙化斑块的深度及广度在2组间没有明显区别,但≥2象限的钙化斑块有多见SAP组趋势。结论:OCT能准确评价冠状动脉受累血管病变的病变特点及结构特征。AMI患者脂质斑块纤维帽更薄,更多见斑块破裂、血栓及不稳定脂质斑块。

AIM：To evaluate the characteristics of the culprit lesion in acute myocardial infarction and stable angina pectoris by optical coherence tomography （OCT）. METHODS： A total of 140 patients undergoing coronary artery angiography （CAG） and OCT were enrolled, including 61 cases （55.3±11.8） of acute ST segment elevation myocardial infarction （AMI） and 79 cases （59.0±9.6） of stable angina pectoris （SAP）. Lesion characteristics were assessed by OCT and related clinical data were analyzed. RESULTS： The minimum thickness of the fibrous cap in AMI group was significantly thinner than in SAP group [（45±13） μm vs. （80±39） μm, P〈0.01] and the thin cap fibroatheroma （TCFA） in AMI group was higher than in SAP group [33 （56%） vs. 17 （25%）, P〈0.01]. Thrombi were more frequently observed in AMI group [32 （52%） vs. 4 （5%）, P〈0.01] and plaque rupture was 41 （67%） in AMI group and 20 （25%） in SAP group （P〈0.01）. AMI patients had a higher incidence of moderate and severe plaque disruption （ulcer＋dissection） than SAP patients and lipidrich plaques （=4 quadrants） were more frequently observed in AMI group. No significant difference was found in the depth and extent of calcification between groups, but calcified plaques （≥2 quadrants） were found more in SAP group. CONCLUSION： OCT can accurately evaluate the characteristics and structure of the culprit lesion in acute myocardial infarction. Thin cap fibroatheromas, more severe plaque disruptions, thrombi and vulnerable plaques are more frequently observed in AMI patients than in SAP patients.