Plaque erosion occurs without cap disruption where flowing blood comes into direct contact with intimal surface lacking endothelial cells. In both clinical studies using intravascular imaging and autopsy data from subjects dying suddenly, plaque erosion is the second most common cause of coronary thrombus. In our recent pathological analysis of autopsies from subjects dying suddenly, plaque rupture was the most frequent causes of coronary thrombus (60%), the second most frequent was erosion (30%), and the third was calcified nodule (5%). The mechanisms leading to plaque erosion remain somewhat elusive, in part because of a lack of representative animal models as well as scarcity of in vivo data. Old imaging techniques such as coronary angiography or intravascular ultrasound lack the resolution needed to differentiate plaque rupture from erosion. The relatively recent introduction of optical coherence tomography (OCT), which measures backscattered light, or optical echoes, derived from an infrared light source directed at the arterial wall to generate higher resolution images of the order of 10–15 mM, has been instrumental in furthering our knowledge of in vivo assessment of coronary artery disease. Previous OCT studies of patients with acute coronary syndromes (ACS) showed a 27–31% prevalence of plaque erosion. Although consistent with the aforementioned pathological work, previous OCT studies consisted of a relatively small number of patients. Overall only eight studies have been performed to examine the prevalence of OCT-defined erosion, a total of 790 ACS patients (range 64–139 in each study), with the total number of cases with erosion 267 (range 25–37 in each study). With such a limited number of subjects with plaque erosion, one wonders about their applicability to the real world. In pathological series, patients with plaque erosion (a total of 148 patients) were younger, more likely to be female, have a history of smoking, and have lower cholesterol levels. Whether this is truly representative of patients coming to the clinic with ACS remains unknown, as does more detailed information about other risk factors. The study by Dai et al. in this issue of the journal represents the largest OCT study to date in patients presenting with ST-elevation myocardial infarction, all of whom had OCT imaging at the time of intervention. A total of 822 patients were suitable for culprit lesion evaluation by OCT, with plaque rupture accounting for 564 (69%) and plaque erosion for 209 (25%). The authors report similar findings to those which have been previously shown in autopsy studies. Overall Dai et al. also demonstrate that plaque erosion is more frequent in younger individuals, is more likely to occur in younger women (i.e. <50 years of age), and is more likely in current smokers. Subjects with plaque erosion had lower total cholesterol and LDL levels as compared with ruptures. Other coronary risk factors such as diabetes, hypertension, dyslipidaemia, and chronic kidney disease (CKD) were less common in erosion vs. rupture. The latter findings are novel, and help to expand our understanding of plaque erosion. Previous pathology analyses by Burke, Farb, Arbustini, and Yahagi were limited by the small number of subjects in each study, lacked detailed clinical data, and lacked statistical power to detect differences. Further. Dai et al. also found differences when examining specifically the culprit lesion. Plaque erosion lesions had a lower percentage of stenosis (64.4 ± 13.3%) and a larger minimal lumen area [(MLA) 1.8 mm (1.4–2.8 mm)] as compared with plaque ruptures [68.6 ± 13.8%, MLA 1.6 mm (1.3–2.2 mm)]. Plaque erosion lesions had a lower prevalence of lipid-rich plaque, less lipid content, and less calcification, and more were frequently located near bifurcations as compared with plaque ruptures. Also, thin-cap fibroatheromas (TCFAs) were less frequently observed in erosion cases than in ruptures (14% vs. 90%; P < 0.001). Positive remodelling is considered the hallmark of rupture, while erosion cases more often demonstrate negative remodelling in pathological studies. Positive remodelling has been linked to higher inflammation in ruptures vs. erosion and this

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光学相干断层扫描定义的斑块侵蚀特征与病理学中的真实侵蚀相似吗？

斑块侵蚀发生而不破坏帽盖，其中流动的血液与缺乏内皮细胞的内膜表面直接接触。在使用血管内成像和突然死亡受试者的尸检数据的两项临床研究中，斑块侵蚀是冠状动脉血栓的第二大常见原因。在我们最近对突然死亡受试者尸体解剖的病理分析中，斑块破裂是冠状动脉血栓最常见的原因 (60%)，第二常见的原因是侵蚀 (30%)，第三是钙化结节 (5%)。导致斑块侵蚀的机制仍然有些难以捉摸，部分原因是缺乏代表性的动物模型以及缺乏体内数据。旧的成像技术，如冠状动脉造影或血管内超声，缺乏区分斑块破裂与侵蚀所需的分辨率。相对最近引入的光学相干断层扫描 (OCT)，它测量背向散射光或光学回波，源自指向动脉壁的红外光源，以生成 10-15 mM 数量级的更高分辨率图像，已有助于进一步了解冠状动脉疾病的体内评估。先前对急性冠状动脉综合征 (ACS) 患者的 OCT 研究显示斑块侵蚀的患病率为 27-31%。尽管与上述病理学工作一致，但以前的 OCT 研究由相对较少的患者组成。总体而言，仅进行了八项研究来检查 OCT 定义的侵蚀的患病率，共有 790 名 ACS 患者（每项研究的范围为 64-139），侵蚀的病例总数为 267（每项研究的范围为 25-37） ）。由于斑块侵蚀的受试者数量如此有限，人们想知道它们在现实世界中的适用性。在病理系列中，斑块侵蚀患者（共 148 名患者）更年轻，更可能是女性，有吸烟史，胆固醇水平较低。这是否真正代表了就诊的 ACS 患者仍然未知，关于其他危险因素的更详细信息也是如此。Dai 等人的研究。在本期杂志中，代表了迄今为止针对 ST 段抬高型心肌梗死患者进行的最大规模的 OCT 研究，所有这些患者在干预时均进行了 OCT 成像。共822例患者适合OCT罪犯病变评估，斑块破裂564例（69%），斑块侵蚀209例（25%）。作者报告的结果与之前在尸检研究中显示的结果相似。总体戴等人。还表明斑块侵蚀在年轻个体中更常见，更可能发生在年轻女性（即 <50 岁）中，并且更可能发生在当前吸烟者中。与斑块破裂的受试者相比，斑块侵蚀的受试者的总胆固醇和低密度脂蛋白水平较低。其他冠状动脉危险因素如糖尿病、高血压、血脂异常和慢性肾病 (CKD) 在侵蚀与破裂中不太常见。后者的发现是新颖的，有助于扩大我们对斑块侵蚀的理解。Burke、Farb、Arbustini 和 Yahagi 之前的病理学分析受到每项研究中受试者数量较少的限制，缺乏详细的临床数据，并且缺乏检测差异的统计能力。更多。戴等人。在具体检查罪犯病变时也发现了差异。与斑块破裂 [68.6 ± 13.8%，MLA 1.6 mm (1.3)] 相比，斑块侵蚀病变的狭窄百分比较低 (64.4 ± 13.3%) 和更大的最小管腔面积 [(MLA) 1.8 mm (1.4–2.8 mm)] –2.2 毫米)]。与斑块破裂相比，斑块侵蚀病变富含脂质斑块的发生率较低，脂质含量较少，钙化较少，并且更常位于分叉附近。此外，与破裂相比，在侵蚀病例中观察到薄帽纤维粥样硬化 (TCFA) 的频率较低（14% 对 90%；P < 0.001）。阳性重塑被认为是破裂的标志，而侵蚀病例在病理研究中更常表现出阴性重塑。积极的重塑与破裂和侵蚀中更高的炎症有关，这