对心血管疾病预防和学科发展的一些思考教程胡大一课件.pptVIP

冠心病患者因冠状动脉粥样硬化斑块引起管腔狭窄时，临床表现为稳定性冠心病的相关症状，但这并不意味着患者的斑块稳定。这时机体可能已经是“危机四伏”，斑块随时可能破裂，引发相应的临床事件。下面我们就来看一些这方面的研究。 除了上面的研究，在其它多项用IVUS检测的研究中都观察到，稳定性心绞痛患者的冠脉中至少一个斑块破裂的发生率可高达约30%。我们知道，急性心血管事件通常是由斑块破裂引发的，所以上述比例不容小觑。 我们知道，ACS患者中可能存在多个不稳定斑块；那么在稳定性心绞痛患者中，情况又如何呢？在如图所示的这项研究中，作者评价了稳定性心绞痛（SA）患者冠脉中有易损特征的斑块的发生率。 在这项研究中，共计入选了67名SA患者（男性n=46，年龄55.9岁）；易损斑块定义为IVUS观察到阳性重构，和动脉造影时出现复杂病变。结果显示，在67个目标病变中，有44.8%为阳性重构，23.9%为复杂斑块；其中31.3%的患者存在多个复杂斑块。 正因为如此，作者在结论中指出：在稳定性心绞痛患者中，约1/3的患者冠脉中存在多个易损斑块。同时，易损斑块的出现具有累积效应，一个易损斑块的出现意味着可能会出现更多的易损斑块。 Background: Development of vulnerable lesion may take place simultaneously at many sites of coronary vasculature, therefore causing multisite instability. The prevalence of the phenomenon in stable angina (SA) patients remains unknown. The aim of our study was to assess, in patients with stable angina, the prevalence of coronary plaques with vulnerable characteristics and to ascertain whether the number of such lesions may accumulate. Methods: Vulnerable plaques are characterised by positive remodelling on intravascular ultrasound (IVUS) and with complex appearance on angiography. We performed preprocedural IVUS in target lesion of 67 patients with SA (46 males, age 55.9). Remodelling index (RI) defined as vessel area at the target lesion divided by that of average reference segments z1.05 was assumed as positive remodelling. Plaques of z30% stenosis on angiography were classified into complex or smooth groups. Results: Positive remodelling was found in 30 (44.8%) and complex plaque in 16 (23.9%) of 67 target lesions. Multiple complex plaques were present in 21 (31.3%) patients. Plaques with positive remodelling more often were complex on angiography (12/30 vs. 4/37, respectively; p=0.005) and were more often associated by complex plaques at other sites (35/30 vs. 23/37; p=0.04) than the remaining lesions. Moreover, the presence of positive remodelling predicted multiple complex lesions at other sites (OR 5.6; 95% CI 1.7–18.3). Conclusion: Multiple