光学相干断层成像技术对STEMI患者冠脉内血栓类型的研究
|
摘要
目的探讨影响STEMI患者不同血栓类型形成的相关因素。方法回顾性收集2014年9月至2018年10月在河南省人民医院接受急诊介入治疗的资料完整、诊断明确的STEMI患者,根据OCT检查的血栓类型将研究对象分为两组,分别是红色血栓组和白色血栓组,并收集STEMI患者的临床基线资料、冠脉造影结果和OCT结果,用多因素logistic回归分析法对血栓类型进行分析。结果研究中入组的92例STEMI患者,血栓检出率100%。根据OCT血栓诊断标准,检出红色血栓73(79.3%)例,白色血栓19(20.7%)例。两组患者在梗死相关血管、梗死部位的分布均无差异,白色血栓组合并多支血管病变的发生率高于红色血栓组;两组患者在斑块破裂、薄纤维帽脂质斑块的发生率上差异有统计学意义(P <0.05),在红色血栓组的发生率较高。斑块破裂(OR=2.894,95%CI 2.704～2.956)、薄纤维帽粥样脂质斑块(OR=8.033,95%CI 7.985～8.283)、单支血管病变(OR=1.746,95%CI 1.659～1.785)是红色血栓形成的危险因素。结论单支血管病变、斑块破裂、薄纤维帽脂质斑块与红色血栓的形成相关;多支血管病变、稳定斑块与白色血栓的形成相关。
Objective To explore the related factors affecting the formation of different types of thrombosis in patients with STEMI. Methods Retrospective data were collected from September 2014 to October 2018 in Henan Province People's Hospital for emergency interventional treatment of patients with STEMI. According to the type of thrombus detected by OCT, they were divided into two groups, which were red thrombus group and white thrombus group. Clinical baseline data, coronary angiographic findings, and OCT results were collected in patients with STEMI. Logistic regression analysis was used to analyze the type of thrombosis in patients with STEMI. Results The rate of thrombus detection was 100% in 92 patients with STEMI. According to OCT diagnostic criteria,73(79.3%) patients were classified into red thrombus and 19(20.7%) were white thrombus. There was no significant difference in infarct-related artery and location between the two groups(P>0.05), but there was more multiple vascular lesions in the white thrombus group than that in the red thrombus group. There was significant difference in the incidence of plaque rupture and thin fibrous cap in the two groups(P<0.05). The incidence of plaque rupture and thin fibrous cap lipid plaque was higher in the red thrombus group. Plaque rupture(OR = 2.894, 95%CI:2.704-2.956), thin fibrous cap plaque(OR = 8.033, 95%CI: 7.985-8.283), single vessel disease(OR = 1.746,95% CI: 1.659-1.785) are risk factors for red thrombosis formation. Conclusion Single vessel lesion, plaque rupture andthin fibrous cap lipid plaque are associated with red thrombus formation.While, multiple vessel lesions and stable plaque are associated with white thrombus formation.
Objective To explore the related factors affecting the formation of different types of thrombosis in patients with STEMI. Methods Retrospective data were collected from September 2014 to October 2018 in Henan Province People's Hospital for emergency interventional treatment of patients with STEMI. According to the type of thrombus detected by OCT, they were divided into two groups, which were red thrombus group and white thrombus group. Clinical baseline data, coronary angiographic findings, and OCT results were collected in patients with STEMI. Logistic regression analysis was used to analyze the type of thrombosis in patients with STEMI. Results The rate of thrombus detection was 100% in 92 patients with STEMI. According to OCT diagnostic criteria,73(79.3%) patients were classified into red thrombus and 19(20.7%) were white thrombus. There was no significant difference in infarct-related artery and location between the two groups(P>0.05), but there was more multiple vascular lesions in the white thrombus group than that in the red thrombus group. There was significant difference in the incidence of plaque rupture and thin fibrous cap in the two groups(P<0.05). The incidence of plaque rupture and thin fibrous cap lipid plaque was higher in the red thrombus group. Plaque rupture(OR = 2.894, 95%CI:2.704-2.956), thin fibrous cap plaque(OR = 8.033, 95%CI: 7.985-8.283), single vessel disease(OR = 1.746,95% CI: 1.659-1.785) are risk factors for red thrombosis formation. Conclusion Single vessel lesion, plaque rupture andthin fibrous cap lipid plaque are associated with red thrombus formation.While, multiple vessel lesions and stable plaque are associated with white thrombus formation.
引文
[1]KOLODGIE F D,BURKE A P,FARB A,et al.The thin-cap fibroatheroma:A type of vulnerable plaque:the major precursor lesion to acute coronary syndromes[J].Curr Opin Cardiol,2001,16(5):285-292.
[2]KRAMER M C,RITTERSMA S Z,DE WINTER R J,et al.Relationship of thrombus healing to underlying plaque morphology in sudden coronary death[J].J Am Coll Cardiol,2010,55(2):122-132.
[3]KUME T,AKASAKA T,KAWAMOTO T,et al.Assessment of coronary arterial thrombus by optical coherence tomography[J].Am J Cardiol,2006,97(12):1713-1717.
[4]HOU J,XING L,JIA H,et al.Comparison of intensive versus moderate lipid-lowering therapy on fibrous cap and atheroma volume of coronary lipid-rich plaque using serial optical coherence tomography and intravascular ultrasound imaging[J].Am J Cardiol,2016,117(5):800-806.
[5]NADKARNI S K,PIERCE M C,PARK H,et al.Measurement of collagen and smooth muscle cell content in atherosclerotic plaques using polarization-sensitive optical coherence tomography[J].Am Coll Cardiol J,2007,49(13):1474-1481.
[6]BOUMA B E,TEARNEY G J,YABUSHITA H,et al.Evaluation of intracoronary stenting by intravascular optical coherence tomography[J].E-Heart,2003,89(3):317-320.
[7]SINCLAIR H,BOURANTAS C,BAGNALL A,et al.OCT for the identification of vulnerable plaque in acute coronary syndrome[J].JACC Cardiovas Imag,2015,8(2):198-209.
[8]ABELA G S,EISENBERG J D,MITTLEMAN M A,et al.Detecting and differentiating white from red coronary thrombus by angiography in angina pectoris and in acute myocardial infarction[J].Am J Cardiol,1999,83(1):94-97.
[9]INO Y,KUBO T,TANAKA A,et al.Difference of culprit lesion morphologies between st-segment elevation myocardial infarction and non-st-segment elevation acute coronary syndrome:An optical coherence tomography study[J].JACC:Cardiovas Intervent,2011,4(1):76-82.
[10]QUADROS A S,CAMBRUZZI E,SEBBEN J,et al.Red versus white thrombi in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention:clinical and angiographic outcomes[J].Am Heart J,2012,164(4):553-560.
[11]杨亚攀,楚英杰.急性心肌梗死患者血栓类型与ST段改变的相关性[J].实用医学杂志,2015,31(20):3311-3313.
[12]MATTHIAS H,TIBOR Z,BAREND M,et al.A different outlook on the role of bone marrow stem cells in vascular growth:bone marrow delivers software not hardware[J].Circulation Research,2004,94(5):573-574.
[13]TIAN J,REN X,VERGALLO R,et al.Distinct morphological features of ruptured culprit plaque for acute coronary events compared to those with silent rupture and thin cap fibroatheroma[J].J Am Coll Cardiol,2014,63(21):2209-2216.
[2]KRAMER M C,RITTERSMA S Z,DE WINTER R J,et al.Relationship of thrombus healing to underlying plaque morphology in sudden coronary death[J].J Am Coll Cardiol,2010,55(2):122-132.
[3]KUME T,AKASAKA T,KAWAMOTO T,et al.Assessment of coronary arterial thrombus by optical coherence tomography[J].Am J Cardiol,2006,97(12):1713-1717.
[4]HOU J,XING L,JIA H,et al.Comparison of intensive versus moderate lipid-lowering therapy on fibrous cap and atheroma volume of coronary lipid-rich plaque using serial optical coherence tomography and intravascular ultrasound imaging[J].Am J Cardiol,2016,117(5):800-806.
[5]NADKARNI S K,PIERCE M C,PARK H,et al.Measurement of collagen and smooth muscle cell content in atherosclerotic plaques using polarization-sensitive optical coherence tomography[J].Am Coll Cardiol J,2007,49(13):1474-1481.
[6]BOUMA B E,TEARNEY G J,YABUSHITA H,et al.Evaluation of intracoronary stenting by intravascular optical coherence tomography[J].E-Heart,2003,89(3):317-320.
[7]SINCLAIR H,BOURANTAS C,BAGNALL A,et al.OCT for the identification of vulnerable plaque in acute coronary syndrome[J].JACC Cardiovas Imag,2015,8(2):198-209.
[8]ABELA G S,EISENBERG J D,MITTLEMAN M A,et al.Detecting and differentiating white from red coronary thrombus by angiography in angina pectoris and in acute myocardial infarction[J].Am J Cardiol,1999,83(1):94-97.
[9]INO Y,KUBO T,TANAKA A,et al.Difference of culprit lesion morphologies between st-segment elevation myocardial infarction and non-st-segment elevation acute coronary syndrome:An optical coherence tomography study[J].JACC:Cardiovas Intervent,2011,4(1):76-82.
[10]QUADROS A S,CAMBRUZZI E,SEBBEN J,et al.Red versus white thrombi in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention:clinical and angiographic outcomes[J].Am Heart J,2012,164(4):553-560.
[11]杨亚攀,楚英杰.急性心肌梗死患者血栓类型与ST段改变的相关性[J].实用医学杂志,2015,31(20):3311-3313.
[12]MATTHIAS H,TIBOR Z,BAREND M,et al.A different outlook on the role of bone marrow stem cells in vascular growth:bone marrow delivers software not hardware[J].Circulation Research,2004,94(5):573-574.
[13]TIAN J,REN X,VERGALLO R,et al.Distinct morphological features of ruptured culprit plaque for acute coronary events compared to those with silent rupture and thin cap fibroatheroma[J].J Am Coll Cardiol,2014,63(21):2209-2216.