Objective This study was designed to report the characteristics of the culprit lesion with plaque without significant angiographic stenosis after acute coronary syndromes(ACS) by intravascular ultrasound(IVUS).Methods After ACS,IVUS was performed in 45 patients (44.3 years ± 11.3) without significant angiographic stenosis (31 ± 15 ％).Patient were divided into two groups:Group with plaque rupture(16 patients) and Group without plaque rupture(29 patients).Qualitative analysis defined the type of plaque,and quantitative analysis evaluated plaque plus media area,plaque volume,plaque burden,and arterial remodeling index.Results All patients with rupture showed soft or mixed plaque,In group with plaquerupture,plaque rupture was associated with a larger plaque burden[(48.6 ± 8.7) ％ vs (38.5 ± 11.8) ％,P＜0.000 5],a more significant plaque plus media area[(7.2 ± 2.6)mm2 vs (5.1±2.4)mm2,P＜0.001],a greater plaque volume[(154.6±101.4)mm3 vs (96.2±82.1)mm3,P＜0.03],and a higher ratio of plaque volume over length[(8.0±4.1)mm3/mm vs (5.9±3.7)mm3/mm,P＜0.003].In group with plaquerupture,positive remodeling was more frequent than negative remodeling(P＜0.005).In group with plaquerupture,there was no significant difference between the two types of remodeling.Conclusion The plaque ruptures responsible for ACS frequently appear on voluminous plaques with a large plaque burden and positive arterial remodeling.%目的 是用血管内超声(IVUS)观察没有显著冠脉狭窄病变的急性冠脉综合征(ACS)患者缺血相关病变斑块的特点.方法 45例经血管造影无显著冠脉狭窄[狭窄(31±15)％]的急性冠脉综合征患者(ACS)行冠脉内IVUS检查.患者分为斑块破裂组(16例)和无斑块破裂组(29例).定性分析确定斑块的类型,定量分析斑块加中膜面积、斑块容积、斑块负荷、血管重构指数.结果 所有破裂的均为软斑块或混合斑块.斑块破裂组斑块破裂与更大的斑块负荷[(48.6±8.7)％vs (38.5±11.8)％,(P＜0.000 5)]、更显著的斑块+中膜面积[(7.2±2.6) mm2 vs (5.1±2.4) mm2,(P＜0.001)]、更大的斑块容积[(154.6±101.4)mm3 vs (96.2±82.1)mm3,(P＜0.03)]、斑决容积与斑块长度比更高[(8.0±4.1)mm3/mm vs (5.9±3.7)mm3/mm,(P＜0.003)]相关,同时,正性重构要多于负性重构(P＜0.005).无斑块破裂组中不同类型的动脉血管重构无明显差异.结论 急性冠脉综合征的病变斑块破裂常发生在斑决负荷较重及有动脉正性重构的大容量斑块.
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