Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 44
Filtrar
1.
EuroIntervention ; 2020 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-33164894

RESUMO

AIMS: To test whether a non-stenting anti-thrombotic strategy was still effective at 4-year follow-up in patients enrolled in the EROSION study and to explore potential predictors of long-term prognosis. METHODS AND RESULTS: Out of 55 patients who completed 1-month follow-up, 52 patients finished 4-year follow-up. The median duration was 4.8 years (4.2 - 5.8 years). The majority of patients remained free from events, and all patients were free from hard endpoints (death, myocardial infarction, stroke, bypass surgery, or heart failure). Only 1 patient had gastrointestinal bleeding, and 11 patients underwent elective target lesion revascularization (TLR). Patients in the non-TLR group had more optical coherence tomography (OCT) thrombus reduction from baseline to 1 month; 95% patients in the non-TLR group versus 45% in the TLR group (p=0.001) met the primary endpoint (thrombus volume reduction >50%). Consistent with the OCT findings, angiographic results showed that the TLR group had less improvement in diameter stenosis (p=0.014) at 1 month compared with non-TLR group. CONCLUSIONS: Four-year follow-up findings reconfirmed the safety of an anti-thrombotic therapy without stenting for erosion-caused acute coronary syndrome. Patients with better response to anti-thrombotic therapy in the first month were less likely to require stent implantation during the next four years.

2.
Atherosclerosis ; 302: 8-14, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32387714

RESUMO

BACKGROUND AND AIMS: Ceramides (Cer) are an atherogenic substance. However, the associations between specific plasma Cer levels and culprit plaque morphology in ST-segment elevation myocardial infarction (STEMI) patients are unclear. METHODS: The study consisted of two parallel cohorts. 100 consecutive patients with STEMI were screened as discovery cohort. In the validation cohort, we separately screened 30 normal donors, 30 stable angina pectoris (SAP) and 315 STEMI patients. All STEMI patients underwent emergency percutaneous intervention (PCI) and optical coherence tomography (OCT) examination for culprit plaque. Based on established diagnostic criteria, STEMI patients were classified into plaque rupture (PR) and plaque erosion (PE) group, respectively. Rapid resolution liquid chromatography coupled with quadrupole time-of-flight mass spectrometry (RRLC-Q-TOF/MS) was used to evaluate plasma Cer levels of the screened patients. RESULTS: STEMI patients had higher plasma Cer(d18:1/16:0), Cer(d18:1/18:0), Cer(d18:1/24:1) and Cer(d18:1/24:0) levels than normal donors and SAP patients (p < 0.001, p < 0.001, p < 0.001, p < 0.001, respectively). Plasma Cer levels were significantly higher in STEMI patients with PR than with PE (p < 0.001, p < 0.001, p = 0.008 and p = 0.006, respectively). The frequency of PR increased with increasing tertiles of plasma Cer (adjusted p for trend = 0.004, 0.044, 0.021 and 0.133, respectively). The fully adjusted per SD odds ratios (95% confidence interval) for PR were 9.375 (2.496-35.215) for Cer(d18:1/16:0), 3.586 (1.588-8.089) for Cer(d18:1/18:0), 8.171 (1.764-37.857) for Cer(d18:1/24:1), and 3.831 (1.288-11.289) for Cer(d18:1/24:10). CONCLUSIONS: The study documented novel, positive and independent associations between plasma Cer concentrations and the presence of PR, suggesting plasma Cer may act as potential biomarkers for PR to improve risk stratification.

3.
Int Heart J ; 60(5): 1061-1069, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484870

RESUMO

Plaque erosion (PE) is a significant substrate of acute coronary thrombosis. An improved ability to distinguish plaque phenotype in vivo among patients with ST-segment elevation myocardial infarction (STEMI) is of considerable interest because of the potential to formulate tailored treatment. This study assessed the plaque features and screened the circulating microRNAs (miRNAs) characteristically expressed in patients with PE compared with those with plaque rupture (PR). An miRNA microarray profile was generated in an initial cohort of eight STEMI patients with PE and eight clinically matched subjects with PR to select the circulating miRNAs with significant differences. miRNAs of interest were validated in a prospective cohort, and the plaque characteristics of enrolled patients were assessed by optical coherence tomography (OCT). Thirty culprit lesions were classified as PE (32.6%) and 46 as PR (50%). The main component of PE was fibrotic tissue, whereas the chief component of PR was lipids (P < 0.001). Thirty-four miRNAs were differentially expressed between the two groups; we validated five candidates and found that only the level of circulating miR-3667-3p exhibited significant discriminatory power in predicting the presence of PE (AUC = 0.767; P < 0.001). Our results show that high levels of circulating miR-3667-3p are closely related to PE in STEMI patients, which provides further evidence for PE pathophysiology and potential tailor treatment strategies.


Assuntos
MicroRNA Circulante/sangue , Trombose Coronária/diagnóstico por imagem , Placa Aterosclerótica/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Tomografia de Coerência Óptica/métodos , Idoso , Área Sob a Curva , Estudos de Casos e Controles , China , Angiografia Coronária/métodos , Trombose Coronária/mortalidade , Trombose Coronária/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/patologia , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Estudos Retrospectivos , Medição de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Estatísticas não Paramétricas , Análise de Sobrevida , Resultado do Tratamento
5.
EuroIntervention ; 15(9): e771-e778, 2019 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-30946013

RESUMO

AIMS: The aim of this study was to determine the prevalence and significance of plaque with a multilayered (ML) pattern in patients with acute coronary syndrome (ACS) versus stable angina pectoris (SAP) using OCT. METHODS AND RESULTS: Two hundred and four patients (144 ACS and 60 SAP) with OCT imaging of the culprit lesions before intervention were studied. ML plaques were identified by OCT as plaque with multiple layers of distinct optical signals. ML plaque was identified in 119 out of 204 (58.3%) patients. ML plaques were more frequently observed in SAP than ACS (75% vs 51.4%, p=0.001). Patients with prior myocardial infarction (MI) had a higher incidence of ML plaque compared with those without (74.4% vs 54.5%, p=0.024). ML plaque had a higher degree of luminal stenosis (p=0.006), longer lesion length (p=0.025), more complex lesion type (B2/C) (p<0.001) on angiography and non-significant larger plaque burden (p=0.07) on IVUS compared with those without an ML pattern. CONCLUSIONS: ML plaques, indicative of prior thrombosis, were frequently identified in patients with CAD, particularly more so in SAP and those with prior MI compared with ACS. The presence of an ML pattern is a marker of a greater extent and severity of CAD, suggesting a pathogenic link between plaque healing and lesion progression.


Assuntos
Síndrome Coronariana Aguda/patologia , Angina Estável/patologia , Placa Aterosclerótica/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Síndrome Coronariana Aguda/epidemiologia , Angina Estável/epidemiologia , Angiografia Coronária , Humanos , Infarto do Miocárdio , Placa Aterosclerótica/epidemiologia , Placa Aterosclerótica/patologia , Prevalência , Ultrassonografia de Intervenção
6.
EuroIntervention ; 14(17): 1768-1775, 2019 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-30277462

RESUMO

AIMS: This study aimed to evaluate the relationship between pre-infarction angina (PIA) and in vivo culprit lesion characteristics as assessed by intravascular optical coherence tomography (OCT) in patients with a first ST-segment elevation myocardial infarction (STEMI). METHODS AND RESULTS: A total of 305 consecutive patients with a first STEMI who underwent OCT imaging of culprit lesions during primary percutaneous coronary intervention (PCI) were prospectively enrolled. OCT findings of the culprit plaque were compared between patients with (n=206) and without PIA (n=99). Patients with PIA showed lower rates of thin-cap fibroatheroma (TCFA) (62.6% vs. 80.8%, p=0.001) and plaque rupture (56.8% vs. 72.7%, p=0.007), smaller maximum ruptured cavity areas (1.10±1.04 mm2 vs. 1.53±1.20 mm2, p=0.002), and more severe residual luminal narrowing (p=0.015) with a higher incidence of white residual thrombus (68.4% vs. 50.0%, p=0.003) at the culprit lesions than patients without PIA. No significant differences in clinical outcomes were observed at the one-year follow-up. CONCLUSIONS: In patients with a first STEMI, PIA was significantly associated with a lower incidence of TCFA and plaque rupture, a smaller ruptured cavity area, more white residual thrombi, and more severe lumen stenosis at the culprit lesions.


Assuntos
Infarto do Miocárdio , Intervenção Coronária Percutânea , Placa Aterosclerótica , Infarto do Miocárdio com Supradesnível do Segmento ST , Angiografia Coronária , Humanos , Infarto , Tomografia de Coerência Óptica
7.
Cardiovasc Diabetol ; 17(1): 90, 2018 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-29907160

RESUMO

BACKGROUND: Raised hemoglobinA1c (HbA1c) is an indicator of pre-diabetes, which is associated with increased risk of coronary artery disease. However, the detailed morphological characteristics of non-culprit plaques in acute coronary syndrome (ACS) patients remain largely unknown. METHODS: A total of 305 non-culprit plaques from 216 ACS patients were analyzed by intravascular optical coherence tomography. These patients were divided into three groups according to the serum glycosylated hemoglobin level: normal HbA1c (< 5.7%), pre-diabetes with raised HbA1c (5.7-6.4%) and diabetes mellitus (DM). RESULTS: Plaques in patients with raised HbA1c had a longer lipid length (17.0 ± 8.3 mm vs. 13.9 ± 7.2 mm, P = 0.004) and greater lipid index (2775.0 ± 1694.0 mm° vs. 1592.1 ± 981.2 mm°, P = 0.001) than those with normal HbA1c but were similar to DM. The prevalence of calcification in patients with raised HbA1c was significantly higher (38.7% vs. 26.3%, P = 0.048) than normal HbA1c but was similar to DM. The percentage of macrophage infiltration in the DM group was higher than that in the normal HbA1c group (20.5% vs. 7.4%, P = 0.005). CONCLUSIONS: Compared to patients with normal HbA1c, the non-culprit plaques in ACS patients with raised HbA1c had more typical vulnerable features but were similar to DM.


Assuntos
Síndrome Coronariana Aguda/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Diabetes Mellitus/sangue , Hemoglobina A Glicada/análise , Placa Aterosclerótica , Estado Pré-Diabético/sangue , Tomografia de Coerência Óptica , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/patologia , Idoso , Biomarcadores/sangue , Angiografia Coronária , Vasos Coronários/patologia , Diabetes Mellitus/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/diagnóstico , Valor Preditivo dos Testes , Estudos Retrospectivos , Regulação para Cima , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/patologia
8.
Eur Heart J ; 39(22): 2077-2085, 2018 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-29547992

RESUMO

Aims: Plaque erosion is a significant substrate of acute coronary thrombosis. This study sought to determine in vivo predictors of plaque erosion in patients with ST-segment elevation myocardial infarction (STEMI). Methods and results: A prospective series of 822 STEMI patients underwent pre-intervention optical coherence tomography. Using established diagnostic criteria, 209 had plaque erosion (25.4%) and 564 had plaque rupture (68.6%). Plaque erosion was more frequent in women <50 years when compared with those ≥50 years of age (P = 0.009). There was a similar, but less striking, trend in men (P = 0.011). Patients with plaque erosion were more frequently current smokers but had fewer other coronary risk factors (dyslipidaemia, hypertension, chronic kidney disease, and diabetes mellitus) than those with plaque rupture. There was a preponderance of plaque erosion in the left anterior descending artery (LAD; 61.2%), whereas plaque rupture was more equally distributed in both the LAD (47.0%) and right coronary artery (43.3%). Despite the similar spatial distribution of erosions and ruptures over the lengths of the coronary arteries, plaque erosion occurred more frequently near a bifurcation (P < 0.001). In the multivariable analysis, age <50 years, current smoking, absence of other coronary risk factors, lack of multi-vessel disease, reduced lesion severity, larger vessel size, and nearby bifurcation were significantly associated with plaque erosion. Nearby bifurcation and current smoking were especially notable in men, while age <50 years was most predictive in women. Conclusions: Plaque erosion was a predictable clinical entity distinct from plaque rupture in STEMI patients, and gender-specific role of risk factors in plaque erosion should be considered.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Placa Aterosclerótica/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Adulto , Distribuição por Idade , Idoso , Fumar Cigarros , Angiografia Coronária , Doença da Artéria Coronariana/epidemiologia , Diabetes Mellitus/epidemiologia , Dislipidemias/epidemiologia , Procedimentos Endovasculares , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/epidemiologia , Estudos Prospectivos , Insuficiência Renal Crônica/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Distribuição por Sexo , Tomografia de Coerência Óptica
9.
Catheter Cardiovasc Interv ; 91(S1): 582-590, 2018 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-29359491

RESUMO

OBJECTIVES: The aim of this study was to determine if spotty calcification decreases the response of plaque progression to statin therapy. BACKGROUND: Previous studies showed that the presence of spotty calcification is a marker of vulnerable plaque. However, the relationship between spotty calcification and plaque progression is not clear. METHODS: Ninety-six nonculprit lipid-rich plaques in 69 patients who received serial optical coherence tomography (OCT) imaging were included. Plaques were divided into three groups: spotty calcification (n = 38), calcified (n = 12) and noncalcified (n = 46) plaques. Spotty calcification was identified by the presence of a lesion <4 mm in length with an arc of calcification <90°. Changes in plaque characteristics and fibrous cap thickness (FCT) at 6 and 12 months under statin therapy were analyzed by OCT. RESULTS: The increase of FCT was sustained from baseline to 6 and 12 months in three groups: spotty calcification (62.8 ± 20.9, 126.4 ± 84.9, and 169.2 ± 81.6 µm, respectively; P < .001), calcified (59.8 ± 17.0, 93.4 ± 51.4, and 155.2 ± 61.7 µm, respectively; P < .001) and noncalcified (60.0 ± 17.2, 125.5 ± 62.1, and 161.0 ± 80.5 µm, respectively; P < .001). Intensive statin induced a greater change in FCT at 12 months than moderate statin in the spotty calcification group (P = 0.034). The mean lipid arc decreased significantly at 12 months from baseline in the three groups (P = 0.004, P = 0.023, and P < .001, respectively). CONCLUSIONS: Statin therapy was effective for plaque stabilization in plaques with and without spotty calcification. Patients with spotty calcification benefitted more from intensive statin than from moderate statin therapy.


Assuntos
Doença da Artéria Coronariana/tratamento farmacológico , Vasos Coronários/efeitos dos fármacos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Placa Aterosclerótica , Tomografia de Coerência Óptica , Calcificação Vascular/tratamento farmacológico , Idoso , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/patologia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Feminino , Fibrose , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do Tratamento , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/patologia
10.
Circ Cardiovasc Interv ; 10(12)2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29246916

RESUMO

BACKGROUND: The initial EROSION study (Effective Anti-Thrombotic Therapy Without Stenting: Intravascular Optical Coherence Tomography-Based Management in Plaque Erosion) demonstrated that patients with acute coronary syndrome caused by plaque erosion might be stabilized with aspirin and ticagrelor without stenting for ≤1 month. However, a long-term evaluation of outcomes is lacking. The aim of this study was to assess whether the initial benefit of noninterventional therapy for patients with acute coronary syndrome caused by plaque erosion is maintained for ≤1 year. METHODS AND RESULTS: Among 53 patients who completed clinical follow-up, 49 underwent repeat optical coherence tomography imaging at 1 year. Median residual thrombus volume decreased significantly from 1 month to 1 year (0.3 mm3 (0.0-2.0 mm3] versus 0.1 mm3 [0.0-2.0 mm3]; P=0.001). Almost half of the patients (46.9%) had no residual thrombus at 1 year. Minimal effective flow area remained unchanged (2.1 mm2 [1.5-3.8 mm2] versus 2.1 mm2 [1.6-4.0 mm2]; P=0.152). Among 53 patients, 49 (92.5%) remained free from major adverse cardiovascular event for ≤1 year: 3 (5.7%) patients required revascularization because of exertional angina and 1 (1.9%) patient had gastrointestinal bleeding. CONCLUSIONS: One-year follow-up optical coherence tomography demonstrated a further decrease in thrombus volume between 1-month and 1-year follow-up. A majority (92.5%) of patients with acute coronary syndrome caused by plaque erosion managed with aspirin and ticagrelor without stenting remained free of major adverse cardiovascular event for ≤1 year. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02041650.


Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Adenosina/análogos & derivados , Aspirina/uso terapêutico , Doença da Artéria Coronariana/tratamento farmacológico , Trombose Coronária/tratamento farmacológico , Vasos Coronários/efeitos dos fármacos , Fibrinolíticos/uso terapêutico , Placa Aterosclerótica , Inibidores da Agregação de Plaquetas/uso terapêutico , Tomografia de Coerência Óptica , Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/patologia , Adenosina/efeitos adversos , Adenosina/uso terapêutico , Adulto , Aspirina/efeitos adversos , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/patologia , Trombose Coronária/diagnóstico por imagem , Trombose Coronária/patologia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Intervalo Livre de Doença , Quimioterapia Combinada , Feminino , Fibrinolíticos/efeitos adversos , Seguimentos , Hemorragia Gastrointestinal/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica , Inibidores da Agregação de Plaquetas/efeitos adversos , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Trombectomia , Ticagrelor , Fatores de Tempo , Resultado do Tratamento
11.
Oncotarget ; 8(16): 27401-27411, 2017 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-28404965

RESUMO

The aim of the study was to investigate the impact of statins therapy on morphological changes of lipid-rich plaques by OCT (optical coherence tomography) in patients with known CHD (coronary heart disease), stratified by FRS. Ninety-seven lipid-rich plaques from sixty-nine patients who received statins therapy and underwent serial OCT images (baseline, 6-month and 12-month) were divided into 2 groups according to the FRS (framingham risk score): low risk group A (FRS<10%, N=35, n=45), moderate to high risk group B (FRS≥10%, N=34, n=52). Fibrous cap thickness (FCT) was measured at its thinnest part 3 times. Baseline characteristics were not different between the 2 groups. FCT sustained increased from baseline to 6-month and 12-month follow up in both group A (59.8±20.4µm, 118.3±62.5µm, and 158.8±83.4µm respectively, P<0.001) and group B (62.2±16.8µm, 125.1±78.7µm, 163.8±75.5µm respectively, P<0.001). Lipid index was significantly decreased in both group A (1862.1±1164.5, 1530.3±1108.7, 1322.9±1080.4, P<0.001) and group B (1646.6±958.5, 1535.1±1049.1, 1258.6±1045, P=0.016). The incidence of TCFA was decreased statistically in both group A (P <0.001) and group B (P <0.001). The patients with known CHD can equivalently benefit from statins therapy by stabilizing the lipid-rich plaques. Patients with moderate to high FRS might benefit more within the first year from event time.


Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Metabolismo dos Lipídeos , Placa Aterosclerótica/metabolismo , Placa Aterosclerótica/patologia , Adulto , Idoso , Biomarcadores , Angiografia Coronária , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Processamento de Imagem Assistida por Computador , Metabolismo dos Lipídeos/efeitos dos fármacos , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/diagnóstico por imagem , Placa Aterosclerótica/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Tomografia de Coerência Óptica
12.
Catheter Cardiovasc Interv ; 89(S1): 592-600, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28318137

RESUMO

OBJECTIVES: To compare vascular healing after drug-eluting stent (DES) implantation between plaque rupture (PR) and plaque erosion (PE). BACKGROUND: Vascular response after stent implantation in patients with PR has been extensively studied. Little is known about vascular healing after stent implantation in PE. METHODS: Sixty-five ACS patients who received optical coherence tomography (OCT) imaging of the culprit lesions both before and after stent implantation at baseline as well as at 6 months were included in this study. Patients were divided into two groups: PR (n = 19) and PE (n = 24). Prestent thrombus burden and poststent intrastent structure (ISS) volume were analyzed during the index procedure. The ratio of uncovered to total stent struts per cross-section score (RUTTS) and neointimal thickness and area were measured at follow-up. RESULTS: OCT imaging showed that compared with PR, PE showed a significantly lower prestent thrombus score (34.2 ± 19.2 vs. 68.6 ± 44.2, P = 0.009) at baseline and a smaller poststent ISS volume (0.7 ± 0.9 mm3 vs. 2.1 ± 1.9 mm3 , P = 0.019). At the 6-month follow-up, PE showed a higher incidence of RUTTS >0.3 (12.2 ± 14.4 vs. 2.0 ± 4.5%, P = 0.003), thinner neointimal thickness (0.05 ± 0.02 mm vs. 0.12 ± 0.08 mm, P = 0.002), and smaller neointimal area (0.5 ± 0.2 vs. 1.2 ± 0.9 mm2 , P = 0.004) compared with PR. In a multivariate logistic model, PE was identified as an independent predictor for RUTTS >0.3. CONCLUSIONS: PE was associated with less favorable healing following DES implantation when compared to PR at 6 months, indicating longer dual-antiplatelet therapy may be necessary for patients with PE. © 2017 Wiley Periodicals, Inc.


Assuntos
Fármacos Cardiovasculares/administração & dosagem , Oclusão Coronária/terapia , Vasos Coronários/efeitos dos fármacos , Stents Farmacológicos , Intervenção Coronária Percutânea/instrumentação , Placa Aterosclerótica , Sirolimo/administração & dosagem , Tomografia de Coerência Óptica , Cicatrização/efeitos dos fármacos , Idoso , Fármacos Cardiovasculares/efeitos adversos , Doença Crônica , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/mortalidade , Trombose Coronária/diagnóstico por imagem , Trombose Coronária/etiologia , Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neointima , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Valor Preditivo dos Testes , Desenho de Prótese , Ruptura Espontânea , Sirolimo/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
13.
Catheter Cardiovasc Interv ; 89(S1): 582-591, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28318139

RESUMO

OBJECTIVES: To compare stent coverage and malapposition in patients with chronic total occlusion (CTO) lesions and non-CTO lesions (including lipid-rich plaque [LRP] and non-lipid-rich plaque [non-LRP]) after drug-eluting stent (DES) implantation by optical coherence tomography (OCT). BACKGROUND: Different initial lesion characteristics may be related to heterogeneous vessel responses after DES implantation. However, the vessel response in patients with CTO and non-CTO lesions after stenting is unclear. Methods We retrospectively enrolled 64 patients with 68 target lesions. All of the patients underwent OCT imaging immediate after stenting and 6 months after stenting. LRP was defined as the plaque with lipid content in ≥2 quadrants. Non-LRP consisted of fibrous, fibrocalcific plaque, and lipid plaque with less than 2 quadrants lipid content. RESULTS: The malapposition (3.0%, 2.6% vs. 0.6%, P = 0.022), tissue protrusion (15.0% vs. 11.0% vs. 6.4%, P < 0.001), and intrastent thrombus (3.8% vs. 2.4% vs. 1.1%, P = 0.012) were more frequent in the CTO and LRP groups. At 6-month follow-up, malapposition (5.0% vs. 1.0% and 0.4%, P = 0.002) and cross sections with uncovered struts (23.4% vs. 8.2% and 6.6%, P < 0.001) were most frequently observed in the CTO group. Although the incidence of stent thrombosis was non-significantly higher in the CTO group than the other two groups, no events were observed in patients with CTO. CONCLUSIONS: Patients with CTO lesions showed unfavorable responses to DES in the acute phase as well as at the 6-month follow-up, indicating the important pathological link between the original lesion morphology underneath the stents and heterogeneous artery healing. © 2017 Wiley Periodicals, Inc.


Assuntos
Oclusão Coronária/terapia , Vasos Coronários/efeitos dos fármacos , Stents Farmacológicos , Intervenção Coronária Percutânea/instrumentação , Tomografia de Coerência Óptica , Idoso , China , Doença Crônica , Angiografia Coronária , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/metabolismo , Oclusão Coronária/mortalidade , Trombose Coronária/diagnóstico por imagem , Trombose Coronária/etiologia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/metabolismo , Feminino , Fibrose , Humanos , Lipídeos/análise , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Placa Aterosclerótica , Valor Preditivo dos Testes , Desenho de Prótese , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia de Intervenção
14.
J Am Heart Assoc ; 6(3)2017 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-28235809

RESUMO

BACKGROUND: Plaque rupture and erosion are the 2 most common mechanisms for acute coronary syndromes. However, the outcome of these 2 distinct pathologies in patients with acute coronary syndromes has never been studied. METHODS AND RESULTS: We retrospectively studied 141 patients with acute coronary syndromes who underwent optical coherence tomography (OCT) imaging of the culprit lesion prior to stenting from the Massachusetts General Hospital OCT Registry. Management (stent versus no stent), poststent OCT findings, and outcomes were compared. Among the 141 culprit lesions, rupture was found in 79 (56%) patients and erosion in 62 (44%). Stent implantation was performed in 77 (97.5%) patients with rupture versus 49 (79.0%) in those with erosion (P<0.001). Immediately after percutaneous coronary intervention, OCT showed a higher incidence of malapposition (37.5% versus 7.3%, P<0.001), thrombus (59.4% versus 14.6%, P<0.001), and protrusion (93.8% versus 73.2%, P=0.008) in the rupture group compared with the erosion group. Plaque rupture was associated with a higher incidence of no reflow or slow flow and distal embolization. Although cardiac event rates were comparable between the two groups at the 1-year follow-up, none of the erosion patients who were treated conservatively without stenting had adverse cardiac events. CONCLUSIONS: Unfavorable poststent OCT findings were more frequent in rupture patients compared with erosion patients. A subset of erosion patients who were treated conservatively without stenting remained free of adverse cardiac events for up to 1 year.


Assuntos
Síndrome Coronariana Aguda/cirurgia , Vasos Coronários/diagnóstico por imagem , Stents Farmacológicos , Procedimentos Endovasculares/métodos , Intervenção Coronária Percutânea/métodos , Placa Aterosclerótica/complicações , Tomografia de Coerência Óptica/métodos , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/etiologia , Angiografia Coronária , Vasos Coronários/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Massachusetts/epidemiologia , Pessoa de Meia-Idade , Placa Aterosclerótica/diagnóstico , Placa Aterosclerótica/cirurgia , Estudos Retrospectivos , Ruptura Espontânea , Resultado do Tratamento
15.
Coron Artery Dis ; 28(3): 209-217, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28059849

RESUMO

OBJECTIVE: Age-related structural and functional changes in vessel wall may affect the time course of vascular response to statin therapy. In this study, we sought to compare the response of lipid-rich plaque to statin therapy in elderly versus younger patients using optical coherence tomography and intravascular ultrasound. PATIENTS AND METHODS: Sixty-nine patients who underwent serial optical coherence tomography and intravascular ultrasound at the time point of baseline, 6, and 12 months were divided into two groups according to median age: group A (age<57 years, n=35) and group B (age≥57 years, n=34). Patients were treated with intensive (atorvastatin 60 mg/day) or moderate (atorvastatin 20 mg/day or rosuvastatin 10 mg/day) statin therapy. RESULTS: A continuous increase in fibrous-cap thickness (FCT) from baseline to 12 months was observed in both groups (P<0.001, <0.001, respectively). Intensive statin induced greater percent change in FCT at 12 months than moderate statin in group B (P=0.020), but not in group A (P=0.251). Mean lipid arc decreased significantly at 12 months in two groups (P<0.001, <0.001, respectively), and this response was delayed for 6 months (P=0.403) and began to decrease during the second 6 months (P<0.001) in group B. Normalized total atheroma volume decreased significantly in group A (P<0.001), but not in group B (P=0.349). CONCLUSION: Statin therapy could stabilize lipid-rich plaque irrespective of age, and intensive statin therapy was more effective than a moderate dose of statin in increasing FCT, particularly in older patients. A delayed response of lipid content and unfavorable change in normalized total atheroma volume to statin were observed in elderly patients.


Assuntos
Atorvastatina/administração & dosagem , Doença da Artéria Coronariana/tratamento farmacológico , Vasos Coronários/efeitos dos fármacos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Placa Aterosclerótica , Rosuvastatina Cálcica/administração & dosagem , Tomografia de Coerência Óptica , Ultrassonografia de Intervenção , Adolescente , Adulto , Fatores Etários , Idoso , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , China , LDL-Colesterol/sangue , Angiografia Coronária , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/patologia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/metabolismo , Vasos Coronários/patologia , Feminino , Fibrose , Humanos , Metabolismo dos Lipídeos/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
16.
Eur Heart J ; 38(11): 792-800, 2017 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-27578806

RESUMO

Aims: Plaque erosion, compared with plaque rupture, has distinctly different underlying pathology and therefore may merit tailored therapy. In this study, we aimed to assess whether patients with acute coronary syndrome (ACS) caused by plaque erosion might be stabilized by anti-thrombotic therapy without stent implantation. Methods and results: This was a single-centre, uncontrolled, prospective, proof-of concept study. Patients with ACS including ST-segment elevation myocardial infarction were prospectively enrolled. If needed, aspiration thrombectomy was performed. Patients diagnosed with plaque erosion by optical coherence tomography (OCT) and residual diameter stenosis <70% on coronary angiogram were treated with anti-thrombotic therapy without stenting. OCT was repeated at 1 month and thrombus volume was measured. The primary endpoint was >50% reduction of thrombus volume at 1 month compared with baseline. The secondary endpoint was a composite of cardiac death, recurrent ischaemia requiring revascularization, stroke, and major bleeding. Among 405 ACS patients with analysable OCT images, plaque erosion was identified in 103 (25.4%) patients. Sixty patients enrolled and 55 patients completed the 1-month follow-up. Forty-seven patients (47/60, 78.3%; 95% confidence interval: 65.8-87.9%) met the primary endpoint, and 22 patients had no visible thrombus at 1 month. Thrombus volume decreased from 3.7 (1.3, 10.9) mm3 to 0.2 (0.0, 2.0) mm3. Minimal flow area increased from 1.7 (1.4, 2.4) mm2 to 2.1 (1.5, 3.8) mm2. One patient died of gastrointestinal bleeding, and another patient required repeat percutaneous coronary intervention. The rest of the patients remained asymptomatic. Conclusion: For patients with ACS caused by plaque erosion, conservative treatment with anti-thrombotic therapy without stenting may be an option.


Assuntos
Trombose Coronária/tratamento farmacológico , Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/etiologia , Angiografia Coronária/métodos , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/tratamento farmacológico , Trombose Coronária/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/etiologia , Variações Dependentes do Observador , Placa Aterosclerótica/diagnóstico por imagem , Placa Aterosclerótica/tratamento farmacológico , Estudos Prospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Tomografia de Coerência Óptica , Resultado do Tratamento
17.
Coron Artery Dis ; 28(2): 135-144, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27922522

RESUMO

OBJECTIVE: The addition of cystatin C to creatinine in calculating the estimated glomerular filtration rate (eGFR) is known to improve the risk prediction for cardiovascular events. We sought to investigate the associations between eGFRs calculated by three Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations and coronary plaque phenotype by optical coherence tomography. PATIENTS AND METHODS: We analyzed 181 nonculprit plaques from 116 coronary artery disease patients. For each patient, the eGFR was calculated using the CKD-EPIcreatinine, CKD-EPIcystatin C, and CKD-EPIcombination equations. Patients were divided into three categories according to the eGFR calculated by each equation (≥90, 60-89, and <60 ml/min/1.73 m). RESULTS: The prevalence of thin-cap fibroatheroma (TCFA) was correlated inversely with eGFR calculated using CKD-EPIcystatin C and CKD-EPIcombination equations, but not using the CKD-EPIcreatinine equation. The best cut-off values of eGFR calculated by these two equations for differentiating TCFA were 83 and 84 ml/min/1.73 m, respectively. Compared with the CKD-EPIcreatinine equation, patients who were reclassified upward or downward categories by the CKD-EPIcystatin C equation were associated with consistently lower [adjusted odds ratio=0.27, 95% confidence interval (CI), 0.08-0.86] and higher (adjusted odds ratio=2.41, 95% CI, 1.08-5.41) prevalence for TCFA, respectively. The net reclassification improvement with cystatin C, compared with creatinine, was 0.45 (95% CI, 0.20-0.69) for TCFA, 0.38 (95% CI, 0.09-0.67) for thrombus, and 0.21 (95% CI, 0.00-0.42) for cholesterol crystals. Results were generally similar for the CKD-EPIcombination equation. CONCLUSION: The use of cystatin C alone or in combination with creatinine, compared with creatinine alone, for GFR estimation strengthens the associations between the eGFR and prevalence of vulnerable plaque characteristics.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Taxa de Filtração Glomerular , Rim/fisiopatologia , Placa Aterosclerótica , Insuficiência Renal Crônica/complicações , Tomografia de Coerência Óptica , Idoso , Biomarcadores/sangue , Distribuição de Qui-Quadrado , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Creatinina/sangue , Cistatina C/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Razão de Chances , Fenótipo , Valor Preditivo dos Testes , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Ruptura Espontânea
18.
Coron Artery Dis ; 27(8): 629-635, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27468140

RESUMO

OBJECTIVES: The aim of this study was to examine coronary plaque morphology after initiation of statins and compare changes in plaque morphology in patients presenting with acute coronary syndrome (ACS) versus stable angina pectoris (SAP). BACKGROUND: ACS is associated with a pan-inflammatory state, and intraplaque features of inflammation correlate with coronary plaque progression. Statins have known anti-inflammatory properties that may contribute toward their beneficial cardiovascular effects. METHODS: Sixty-nine statin-naive patients (ACS, n=55; SAP, n=14) underwent baseline imaging with optical coherence tomography and intravascular ultrasound. Repeat imaging was performed at 6 and 12 months. A total of 97 nonculprit plaques were analyzed (ACS, n=74; SAP, n=23). RESULTS: Fibrous cap thickness increased in both ACS and SAP patients (all P<0.001 compared with the baseline); the ACS group showed greater percent change in fibrous cap thickness at 12 months (192.8±148.9% in ACS vs. 128.2±88.7% in SAP, P=0.018). The ACS group also showed a significant decrease in plaque microvessels (44.6% at baseline vs. 26.6% at 12 months, P=0.0386). CONCLUSION: Compared with patients with SAP, patients presenting with ACS show more favorable changes in plaque morphology after starting statin treatment. This supports a potential additive benefit of statins in the inflammatory state of ACS and reaffirms the clinical importance of statin therapy for coronary atherosclerosis.


Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Angina Estável/tratamento farmacológico , Anti-Inflamatórios/uso terapêutico , Estenose Coronária/tratamento farmacológico , Vasos Coronários/efeitos dos fármacos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Placa Aterosclerótica , Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/patologia , Adulto , Idoso , Angina Estável/diagnóstico por imagem , Angina Estável/patologia , Angiografia Coronária , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/patologia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fatores de Tempo , Tomografia de Coerência Óptica , Resultado do Tratamento , Ultrassonografia de Intervenção
19.
Am J Cardiol ; 117(12): 1890-5, 2016 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-27138187

RESUMO

Although the clinical benefit of statins have been demonstrated in both genders, gender differences in the response to statin therapy on plaque morphologic changes have not been reported. A total of 66 nonculprit plaques from 46 patients who had serial image acquisition at baseline, 6 months, and 12 months by both optical coherence tomography and intravascular ultrasound (IVUS) were included. Patients were treated with atorvastatin 60 mg (AT60) or 20 mg (AT20). The baseline characteristics were similar between women (n = 16) and men (n = 30) except for age (59.3 ± 6.8 vs 52.5 ± 10.6 years, p = 0.027) and smoking status (12.5% vs 70.0%, p <0.001). The change in fibrous cap thickness (FCT) at 12 months was significant in both groups (108.8 ± 87.4 µm, p <0.001, 91.3 ± 70.1 µm, p <0.001, respectively) without significant difference between the groups (p = 0.437). The percent change in mean lipid arc at 6 months was significantly greater in women than that in men (-12.8 ± 18.8% vs -1.56 ± 21.8%, p = 0.040). In women, the percent change of FCT in the AT20 group was similar to that in the AT60 group (182.5 ± 199.5% vs 192.9 ± 149.7%, p = 0.886). However, in men, the percent change of FCT in the AT20 group was significantly smaller than that in the AT60 group (92.2 ± 90.5% vs 225.9 ± 104.3%, p <0.001). No significant change in percent atheroma volume by IVUS was seen at 12 months in both women and men. In conclusion, statin therapy was effective in both genders for plaque stabilization at 12-month follow-up. High-intensity statin therapy may be particularly important in men.


Assuntos
Atorvastatina/administração & dosagem , LDL-Colesterol/sangue , Doença da Artéria Coronariana/diagnóstico , Vasos Coronários/diagnóstico por imagem , Placa Aterosclerótica/diagnóstico , Tomografia de Coerência Óptica/métodos , Ultrassonografia de Intervenção/métodos , Anticolesterolemiantes/administração & dosagem , LDL-Colesterol/efeitos dos fármacos , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/tratamento farmacológico , Vasos Coronários/efeitos dos fármacos , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Placa Aterosclerótica/sangue , Placa Aterosclerótica/tratamento farmacológico , Reprodutibilidade dos Testes , Fatores Sexuais , Método Simples-Cego , Fatores de Tempo
20.
Am J Cardiol ; 117(5): 800-6, 2016 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-26778524

RESUMO

Despite marked clinical benefit, reduction in atheroma volume with statin therapy is minimal. Changes in plaque composition may explain this discrepancy. We aimed in the present study to assess the effect of statin therapy on coronary plaque composition and plaque volume using serial multimodality imaging. From an open-label, single-blinded study, patients with angiographically mild-to-moderate lesion were randomized to receive atorvastatin 60 (AT 60) mg or atorvastatin 20 (AT 20) mg for 12 months. Optical coherence tomography was used to assess fibrous cap thickness (FCT) and intravascular ultrasound to assess atheroma burden at 3 time points: baseline, at 6 months, and at 12 months. Thirty-six lipid-rich plaques in 27 patients with AT 60 mg and 30 lipid-rich plaques in 19 patients with AT 20 mg were enrolled in this study. Low-density lipoprotein cholesterol level was significantly decreased at 6 months without further reduction at 12 months. AT 60 mg induced greater reduction in low-density lipoprotein cholesterol compared with AT 20 mg. Optical coherence tomography revealed continuous increase in FCT from baseline to 6 months and to 12 months in both groups. AT 60 mg induced greater increase in FCT compared with AT 20 mg at both follow-up points. The prevalence of thin-cap fibroatheroma and the presence of macrophage at 6 months were significantly lower in AT 60 mg compared with AT 20 mg. Plaque burden did not change significantly in both groups. In conclusion, both intensive and moderate statin therapy stabilizes coronary plaques, with a greater benefit in the intensive statin group. However, no significant changes in plaque volume were observed over time regardless of the intensity of statin therapy.


Assuntos
Doença da Artéria Coronariana/tratamento farmacológico , Hipolipemiantes/administração & dosagem , Lipídeos/sangue , Placa Aterosclerótica/tratamento farmacológico , Tomografia de Coerência Óptica/métodos , Ultrassonografia de Intervenção/métodos , Adolescente , Adulto , Idoso , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/diagnóstico , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Relação Dose-Resposta a Droga , Feminino , Fibrose/diagnóstico por imagem , Fibrose/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/sangue , Placa Aterosclerótica/diagnóstico , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Método Simples-Cego , Resultado do Tratamento , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA