| Objective:The aim of this study was to observe and analyze the characteristics of culprit lesion in patients with acute coronary syndromes(ACS)by optical coherence tomography(OCT).Methods:This study enrolled patients with ACS checked by OCT from March 2015 to February 2017 in the Second Hospital of Hebei Medical University,the five departments of the hospital.General information was collected after admission,including:age,body weight,history of smoking,history of hypertension and diabetes,the level of total cholesterol,total triglyceride,low density lipoprotein,CK-MB,blood urea nitrogen,serum creatinine,GRACE score,CRUSADE score.Coronary angiography and OCT examination were performed electively to analyze the characteristics of the culprit lesion of STEMI and NSTE-ACS,and the presence of myocardial ischemia was recorded during the examinations.Serum creatinine levels were measured within 72 hours postoperatively and compared with the baseline level at admission.All the patients was followed up for 30 days,and the occurrence of MACE was compared between the two groups.SPSS 20.0statistical software was used for data analysis and P<0.05 was defined as statistically significance.Results:1 A total of 23 patients were enrolled,and there were 11 patients with STEMI and 12 patients with NSTE-ACS.There was no significant difference in age,body weight,history of smoking,history of hypertension,diabetes and ischemic cerebrovascular disease,the level of total cholesterol,total triglyceride,low density lipoprotein,CK-MB,blood urea nitrogen,serum creatinine,CRUSADE score.The GRACE score in patients with STEMI was higher than that in patients with NSTE-ACS(133.91±14.22 vs.111.17±11.34,P=0.000).2 There was no significant difference in the incidence of plaque erosion and plaque erosion and vulnerable plaque between STEMI and NSTE-ACS patients(54.5% vs.16.7%,P=0.057;18.2% vs.0,P=0.122;63.6% vs.66.7%P=0.879),but the incidence of thrombosis was statistically significantly different(54.4% vs.8.3%,P=0.016).No calcification nodule,coronary artery spasm and spontaneous coronary artery dissection were found in both groups.The incidence of plaque rupture in ACS patients with diabetes mellitus was significantly higher than in that without diabetes mellitus(71.4% vs.18.8%,P=0.015).3 Compared with coronary angiography,OCT combined with CAG had a longer operation time(28.98±3.19 vs.41.53±7.28 P=0.000)and a more amount of contrast agent(74.09±15.46 vs.99.30±17.97 P=0.000).During the examination,there was no significant difference in the incidence of myocardial ischemia(4.3% vs.8.7% P=0.55).There was no statistically significant difference in serum creatinine levels between baseline and within72 hours after surgery(P=0.740).There was no patient with contrast induced nephropathy.Followed up for 30 days,only 1 patient with NSTE-ACS had recurrent angina,and no other patients had MACE events.Conclusion:1 It is effective to observe the characteristics of culprit lesion in patients with STEMI and NSTE-ACS by OCT technique.2 There were differences in the characteristics of the culprit lesions between STEACS and NSTE-ACS patients.3 OCT examination is safe and effective in patients with acute coronary syndromes. |
