光学相干断层成像对急性冠状动脉综合征患者非罪犯病变易损斑块的分析及预后评估的研究

Optical coherence tomography detection of non-culprit coronary lesions vulnerable plaques at high risk of developing major adverse cardiovascular events

目的探讨光学相干断层成像(OCT)对急性冠状动脉综合征(ACS)患者非罪犯病变易损斑块性质的分析及对未来发生主要不良心血管事件(MACE)风险的预测价值。方法选取新疆医科大学第一附属医院2015年2月至2022年2月收治的接受经皮冠状动脉介入治疗及OCT检查的ACS患者488例作为研究对象,应用OCT对非罪犯病变进行分析,并对患者进行随访,中位随访时间为5(3,7)年。应用Kap lan-Me ier估计MACE的累积发病率,多变量Cox回归分析非罪犯病变中OCT参数发生MACE的风险,采用受试者工作特征(ROC)曲线评估OCT参数对非罪犯病变发生MACE的预测价值。结果共检查出749个非罪犯病变,41个MACE由OCT成像的非罪犯病变引起。MACE发生率与具有薄纤维帽斑块(TCFA)和最小管腔面积(MLA)<3.5 mm^(2)特征的易损斑块明显相关(33%比3%;HR 13.62,95%CI 6.71~27.65,P<0.001)。多变量Cox回归分析显示,较小的最薄纤维帽厚度(HR 0.97,95%CI 0.96~0.99,P<0.001),较大的最大脂质弧度(HR 1.02,95%CI 1.01~1.03,P<0.001)和较小的MLA(HR 0.31,95%CI 0.18~0.55,P<0.001)是非罪犯病变未来发生MACE的独立危险因素。最薄纤维帽厚度预测非罪犯病变发生MACE的ROC曲线下面积(AUC)为0.858(95%CI 0.802~0.913),最佳截断值为66.5μm;最大脂质弧度预测非罪犯病变发生MACE的AUC为0.853(95%CI 0.786~0.920),最佳截断值为180.35°;MLA预测非罪犯病变发生MACE的AUC为0.821(95%CI 0.766~0.876),最佳截断值为3.575 mm^(2)。结论具有TCFA和MLA<3.5 mm^(2)特征的非罪犯病变与随后发生MACE的风险增加明显相关,最薄纤维帽厚度、最大脂质弧度和MLA对非罪犯病变未来发生MACE有一定的预测价值。

Objective To investigate the value of optical coherence tomography(OCT)in predicting the risk of major adverse cardiovascular events(MACE)in pa tients of acute coronary syndrome(ACS).Methods Four hundred and forth-eight ACS patients admitted to the First Affiliated Hospital of Xinjiang Medical University who underwent percutaneous coronary intervention(PCI)and OCT from February 2015 to February 2022 were selected as the study subjects.We found 749 non-culprit coronary lesions.And follow up the patients,median follow-up was 5 years[interquartile int erval(IQR):3-7 years].Kaplan-meier was used to estimate the cumulative incidence of MACE,multivariate Cox regr ession was used to analyze the risk of MACE with OCT parameters non-culprit coronary lesions,and receiver operating characteristic(ROC)curve was used to evaluate the predictive value of OCT parameters for MACE in non-culprit coronary lesions.Results A total of 749 non-culprit coronary lesions were detected,and 41 MACE cases were caused by non-culprit coronary lesions imaged by OCT.Compared with plaques without thin-cap fibroatheroma(TCFA)and minimal lumen area(MLA)<3.5 mm^(2),the incidence of MACE was significantly associated with vulnerable plaques with TCFA and MLA<3.5 mm^(2)(33%vs.3%,HR 13.62,95%CI 6.71-27.65,P<0.001).Multivariate Cox regression analysis showed that larg er maximum lipid arc(HR 1.02,95%CI 1.01-1.03,P<0.001),smaller maximum lipid cap thickness(HR 0.97,95%CI 0.96-0.99,P<0.001)and MLA(HR 0.31,95%CI 0.18-0.55,P<0.001)were independent risk factors for MACE.The area under ROC curve(AUC)of the thinnest fiber cap thickness for predicting MACE occurrence was 0.858(95%CI 0.802-0.913),and the optimal cutoff value was 66.5μm.The AUC of maximum lipid arc for predicting MACE occurrence was 0.853(95%CI 0.786-0.920),and the optimal cut-off value was 180.35°.The AUC of MLA for predicting MACE was 0.821(95%CI 0.766-0.876),and the optimal cutoff was 3.575 mm^(2).Conclus ions The non-culprit coronary lesions with TCFA and MLA<3.5 mm^(2)were significantly associated with an increased risk of subsequent MACE development at the lesion level,and OCT imaging helps early identification of the risk of MACE development in non-culprit coronary lesions in patients of ACS.