| Objective:This study used OCT to retrospectively analyzed the relationship between coronary lipid plaque and clinical prognosis in 138 patients with coronary heart disease who did not undergo interventional therapy,and explored the clinical significance of lipid plaque.In the course of clinical work,we found that lipid plaques are not only found in unstable plaques,but also in some stable plaques with thick fibrous caps.The significance of this kind of lipid plaque is not completely clear,and its progress is not known either.Therefore,we will analyze the clinical significance of this part of lipid plaque.Methods:1.Screening and grouping patients164 CHD patients who hospitalized in the Department of Cardiology,Second Hospital of JiLin University from February 2014 to August 2018,underwent coronary angiography and OCT detection during hospitalization and then temporarily adopted conservative drug treatment and screened according to diagnostic criteria and exclusion criteria.138 patients were finally enrolled and according to whether there were lipid plaques in the coronary,these patients were divided into non-lipid plaque group(40 cases)and lipid plaque group(98 cases).According to whether cardiovascular adverse events occurred,they were divided into non-adverse event group(117 cases)and adverse event group(21 cases).Definition of cardiovascular adverse events includes:re-hospitalization because of angina,myocardial infarction,coronary revascularization,cardiogenic death.2.Clinical data collection of patientsThe collection of data includes: general clinical data,laboratory test indicators,clinical symptom classification,discharge medication.Then patients prognostic information is collected by telephone follow-up.Futhermore,OCT was used to measure the length of lipid plaque,fiber cap thickness,narrowest lumen area,and stenosis in each patient in the lipid plaque group.And the fine structures such as intravascular nourishing blood vessels,cholesterol crystals,macrophages,plaque rupture,thrombus,and intimal tear were observed.3.Statistical analysis was performed on all collected data to compare whether there were statistical differences between the lipid plaque group and the non-lipid plaque group in the above data and prognosis.Analyzing of risk factors and plaque characteristics that lead to adverse events.And using the receiver operating characteristic curve to evaluate the predictive value of lipid plaque length,fibrous cap thickness,narrowest lumen area,and stenosis for patient prognosis.Results:1.Through comparison of lipid plaque group and non-lipid plaque group,we found that:(1)General clinical data is not statistically significant(p>0.05).There were statistical differences in TG,TC,LDL-c,and hs-CRP in laboratory test indicators(p<0.05)and these indicators were higher in the lipid group.Futhermore,increased hs-CRP is one of the risk factors.The remaining indicators were not statistically significant.(2)It was found by statistics that the incidence of re-hospitalization due to angina after discharge in the lipid plaque group was higher than that of the non-lipid plaque group(p<0.05).There were no statistical differences in other adverse cardiovascular events(p>0.05).2.Quantitative and qualitative data analysis of OCT found that patients with adverse events had longer lipid plaque lengths,thinner fibrous caps,heavier stenosis,and narrower blood vessels than those without adverse events(p<0.05).Lipid plaque length and stenosis can be used as indicators to predict re-hospitalization of angina(AUC>0.5).The best cut-off values for predicting adverse events were lipid plaque length longer than 9 mm and stenosis greater than 61%.Combination of these two indicators yielded better predictability(AUC=0.785)higher sensitivity and specificity.However,fiber cap thickness is poorly predictable(AUC<0.5)Conclusion:1.hs-CRP is one of the important risk factors for cardiovascular adverse events.2.Intracoronary lipid plaques in patients with coronary heart disease who have not been treated with intervention have predictive prognostic significance.It is positively correlated with the incidence of rehospitalization because of angina. |
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