To Evaluate Pathology And Treatment Of Acute Coronary Syndrome With Angioscopy

Preface:Acute myocardial infarction, unstable angina pectoris, ischemic sudden deaths are all involved in acute coronary syndrome (ACS). Coronary plaque rupture followed by the formation of thrombus has been revealed to be a major cause of acute coronary syndrome, which is the main cause of ACS pathology. And the incidence of ACS is quite high in the patients accompanied with the risk factors of coronary heart disease such as smoking, hyperlipidemia, diabetes and so on. Many factors are involved in this process. It's suggested that the tissue characteristics, inflammatory cell infiltration, inner pressure of plaque, mechanics forces and cytokines interact during this process.Furthermore, according to coronary angioscopy, the lesions became more severe with age increasing. The stenotic lesion is an important risk factor. More severe the stenosis was, higher the incidence of coronary artery disease was. However, ACS wasn't induced by the most severe lesions. The unparallel phenomenon between the lesion and pathogenesis suggested that we had toinvestigate the mechanism of higher incidence of ACS in elder people. Because coronary angiography can't identify the intimal cavity of vessels and predict the onset of ACS, we need a new method to evaluate the stenosis more clearly.In recent years, with the employment of interventional therapy, the mortality became lower in ACS, however, there are also some problems such as acute occlusion of coronary artery and restenosis after procedure. It is not clear that the influence of different interventional therapy on all these complication.Angioscopy allows direct visualization of the coronary artery lumen and provides detailed information regarding the surface characteristics of the vessel wall and specific lesions causing acute coronary syndromes. Disruption of a plaque, color and features of thrombus can be readily detected in vivo. Angiographies haven't all these merits.According to present researches, dark yellow plaque revealed by angioscopy may be valuable for prediction of the plaque rupture preceding ACS.Luminal thrombus rather than mural thrombus tended to cause stenosis and occlusion of vessels. The dark yellow plaque and Luminal thrombus are easy to cause ACS.Objective:To investigate the pathologic mechanism of high incidence of ACS in high-age patients and the relationship between the formationof the unstable atheromatous plaque and the risk factors of coronary heart disease, and to evaluate the effect of procedures in ACS, with the angioscopy to observe the plaque and thrombus in coronary artery,Objective:The study group consisted of 51 patients (31 AMI and 20 unstable angina pectoris). Forty-one male and ten female patients were involved in this study. The age varied from 35 to 80 with average age of 62. They were classified into elderly group (more than 65 years old, 24 cases) and non-elderly group (less than 65 years old, 27 cases). Among 31 AMI patients (22 male, 9 female, average age 61), fourteen patients underwent PTCA and ten patients underwent PTCR.Fifteen patients accepted stent implantation.According to the existence of unstable plaque which was observed through angioscopy , the patients were divided into two groups-stable plaque group(36 cases) and unstable plaque group(44 cases). Among eighty patients, forty ones with ischemic heart diseases received both intracoronary ultrasound imaging and angioscopy.Methods:Angioscopy was utilized to observe the color of plaque in culprit vessels and non-culprit ones. The color and morphology ofthrombus were evaluated immediately post- procedures and one month after procedures.Angioscopy was manufactured by Clinical Supply Company. The plaques were classified into 4 groups according to the color (0,white, 1, buff, 2 yellow, 3,dark yellow). Accordingly, the thrombus were classified into 3 groups (white, red, white-red mixed). They also presented luminal thrombus or mural thrombus according to the configuration of thrombus .The t test and x2 test were applied when appropriate. Logistic regression is applied in multivariate analysis. Differences were considered significant when P<0.05.Results:The angioscopy were performed in all 51 patients. Of all these culprit lesions, the yellow plaque existed in 79% elder patients and 80% alternate ones. These were no significant difference between the two groups. And the color scores of two groups are 1.88 ± 1.19 VS 1.44 ± 1.99 (P=0.2, no significant differences). In non-culprit lesions group, the color score was 2.26 ± 0.05 (elderly groups) VS 1.88 ± 0.71 (non- elderly group) (P =0.004, significant difference).We investigated the relationships between the unstable atheromatous plaque and the risk factors of coronary heart diseases in 80 patients by means of angioscopy. The result indicated the incidence of unstable plaque formation, which is 70.5%, 93.2% and 34.1% respectively, is higher in patients accompanied with smoking,hyperlipidemia, diabetes than the one in patients of stable plague group which is 47.2%, 61.0%, 13.9% correspond to the former,. p<0.05, so the result is statistical meaningful. Smoking is especially high tied up with the formation of unstable plaque.Forty patients with ischemic heart diseases received both intracoronary ultrasound imaging and angioscopy. The data suggested yellow plaque was related to positive remodeling while white plaque was related to negative remodeling. Yellow plaque was unstable vulnerable one with high expandability and enlargementIn 31 patients undergoing angioscopy post-procedure immediately, mural thrombus existed in all 15 patients who accepted stent implantation. No luminal thrombus existed in this group. Red luminal thrombus were detected in PTCR (12 cases) and PTCA (9 cases) groups. One month later, the images revealed that 1 patient developed red-white mixed luminal thrombus and 14 patients presented white mural thrombus. White luminal thrombus occurred in PTCA group (13 patients) and PTCR group (9 patients). There were no significant differences in all groups.Conclusions:Angioscopy and intracoronary ultrasound images in ACS suggested yellow plague existed in both culprit and non- culprit vessels in elder patients .We predicted that ACS occurred more frequently when dark yellow plaque existed. The risk factors of...