BACKGROUND Healed plaques are frequently found in patients with acute coronary syndrome,but the prognostic value is debatable.This study investigated the clinical features of non-culprit healed plaques detected by opt...BACKGROUND Healed plaques are frequently found in patients with acute coronary syndrome,but the prognostic value is debatable.This study investigated the clinical features of non-culprit healed plaques detected by optical coherence tomography(OCT)with the aim of predicting plaque progression of healed plaques.METHODS This study retrospectively analyzed 113 non-culprit lesions from 85 patients who underwent baseline OCT ima-ging and follow-up angiography from January 2015 to December 2019.Plaque progression predictors were assessed by multivariate analysis.RESULTS Among 113 non-culprit lesions,27 healed plaques(23.9%)were identified.Patients with non-culprit healed plaques had prior antiplatelet therapy(65.0%vs.33.8%,P=0.019),hypertension(85.0%vs.50.7%,P=0.009),and dyslipidemia(70.0%vs.41.5%,P=0.04)which were more frequently than those without healed plaques.The thickness(r=0.674,P<0.001),arc(r=0.736,P<0.001),and volume(r=0.541,P=0.004)of healed plaque were correlated with minimum lumen diameter changes.At a mean follow-up of 11.5 months,the non-culprit healed plaques had a lower minimum lumen diameter(1.61±0.46 mm vs.1.91±0.73 mm,P=0.016),lower average lumen diameter(1.86 mm vs.2.10 mm,P=0.033),and a higher degree of diameter stenosis(41.4%±11.9%vs.35.5%±13.1%,P=0.031)when compared to baseline measurements.The plaque progression rate was higher in the healed plaque group(33.3%vs.8.1%,P=0.002),and multivariate analysis identified healed plaques[odds ratio(OR)=8.49,95%CI:1.71−42.13]and lumen thrombus(OR=10.69,95%CI:2.21−51.71)as predictors of subsequent lesion progression.CONCLUSIONS Healed plaques were a predictor for rapid plaque progression.The quantitative parameters of healed plaque showed a good agreement with plaque progression.Patients with healed plaque were associated with prior antiplatelet therapy and high level of low-density lipoprotein cholesterol.Bifurcation lesions might be the predilection sites of healed plaques.展开更多
Severe coronary stenosis concomitant with congenital coronary myocardial bridge(MB)is a tough scenario for cardiologist to perform revascularization,for which the complication rates including in-stent restenosis,stent...Severe coronary stenosis concomitant with congenital coronary myocardial bridge(MB)is a tough scenario for cardiologist to perform revascularization,for which the complication rates including in-stent restenosis,stent fracture,stent thrombosis and even coronary perforation are still high.[1,2]Meanwhile,the necessity of revascularization in such patients is worth prudent evaluation.Cardiac imaging modalities are crucial and helpful in making revascularized decisions and strategies.Herein,we report a case using quantitative flow ratio(QFR)and intravascular ultrasound(IVUS)to facilitate accurate revascularization in a patient with both severe coronary stenosis and deep coronary MB.展开更多
文摘BACKGROUND Healed plaques are frequently found in patients with acute coronary syndrome,but the prognostic value is debatable.This study investigated the clinical features of non-culprit healed plaques detected by optical coherence tomography(OCT)with the aim of predicting plaque progression of healed plaques.METHODS This study retrospectively analyzed 113 non-culprit lesions from 85 patients who underwent baseline OCT ima-ging and follow-up angiography from January 2015 to December 2019.Plaque progression predictors were assessed by multivariate analysis.RESULTS Among 113 non-culprit lesions,27 healed plaques(23.9%)were identified.Patients with non-culprit healed plaques had prior antiplatelet therapy(65.0%vs.33.8%,P=0.019),hypertension(85.0%vs.50.7%,P=0.009),and dyslipidemia(70.0%vs.41.5%,P=0.04)which were more frequently than those without healed plaques.The thickness(r=0.674,P<0.001),arc(r=0.736,P<0.001),and volume(r=0.541,P=0.004)of healed plaque were correlated with minimum lumen diameter changes.At a mean follow-up of 11.5 months,the non-culprit healed plaques had a lower minimum lumen diameter(1.61±0.46 mm vs.1.91±0.73 mm,P=0.016),lower average lumen diameter(1.86 mm vs.2.10 mm,P=0.033),and a higher degree of diameter stenosis(41.4%±11.9%vs.35.5%±13.1%,P=0.031)when compared to baseline measurements.The plaque progression rate was higher in the healed plaque group(33.3%vs.8.1%,P=0.002),and multivariate analysis identified healed plaques[odds ratio(OR)=8.49,95%CI:1.71−42.13]and lumen thrombus(OR=10.69,95%CI:2.21−51.71)as predictors of subsequent lesion progression.CONCLUSIONS Healed plaques were a predictor for rapid plaque progression.The quantitative parameters of healed plaque showed a good agreement with plaque progression.Patients with healed plaque were associated with prior antiplatelet therapy and high level of low-density lipoprotein cholesterol.Bifurcation lesions might be the predilection sites of healed plaques.
基金supported by grants from National Key R&D Program of China (2016YFC1300304)
文摘Severe coronary stenosis concomitant with congenital coronary myocardial bridge(MB)is a tough scenario for cardiologist to perform revascularization,for which the complication rates including in-stent restenosis,stent fracture,stent thrombosis and even coronary perforation are still high.[1,2]Meanwhile,the necessity of revascularization in such patients is worth prudent evaluation.Cardiac imaging modalities are crucial and helpful in making revascularized decisions and strategies.Herein,we report a case using quantitative flow ratio(QFR)and intravascular ultrasound(IVUS)to facilitate accurate revascularization in a patient with both severe coronary stenosis and deep coronary MB.
