急性冠症候群または安定冠動脈疾患発症の差異に関連する因子についての検討
【目的】急性冠症候群 (ACS) または安定冠動脈疾患 (SCAD) 患者の背景ならびに経皮的冠動脈インターベンション (PCI) 対象責任病変の特徴を比較することで,ACSならびにSCAD発症病態の差異に関連する因子を探索すること.【方法】血管内超音波 (IVUS) ガイド下でPCIを行った連続 513名 (ACS 392名,SCAD 121名) を対象とし,背景因子,冠危険因子,内服薬,冠動脈造影所見について調査し,冠動脈責任病変のプラーク面積,冠動脈プラーク組成をVirtual Histology IVUS (VH-IVUS) を用いて解析した.これらの変数をACS群とSCAD群間で比較...
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Published in | 日本冠疾患学会雑誌 Vol. 22; no. 3; pp. 139 - 144 |
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Main Authors | , , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | Japanese |
Published |
特定非営利活動法人 日本冠疾患学会
2016
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Subjects | |
Online Access | Get full text |
ISSN | 1341-7703 2187-1949 |
DOI | 10.7793/jcoron.22.16-00006 |
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Abstract | 【目的】急性冠症候群 (ACS) または安定冠動脈疾患 (SCAD) 患者の背景ならびに経皮的冠動脈インターベンション (PCI) 対象責任病変の特徴を比較することで,ACSならびにSCAD発症病態の差異に関連する因子を探索すること.【方法】血管内超音波 (IVUS) ガイド下でPCIを行った連続 513名 (ACS 392名,SCAD 121名) を対象とし,背景因子,冠危険因子,内服薬,冠動脈造影所見について調査し,冠動脈責任病変のプラーク面積,冠動脈プラーク組成をVirtual Histology IVUS (VH-IVUS) を用いて解析した.これらの変数をACS群とSCAD群間で比較したのち,ACSを目的変数とした多重ロジスティック回帰分析を行った.【結果】HDLコレステロール (high density lipoprotein cholesterol: HDL-C) はACS群でSCAD群より低く (43.5 ± 13.1 mg/dl vs 48.1 ± 18.1 mg/dl, p=0.002), スタチン, アンジオテンシン変換酵素阻害薬 (ACEI) またはアンジオテンシンII受容体拮抗薬 (ARB) およびβ遮断薬内服が低率であった (12.8% vs 36.4%, p<0.001; 22.7% vs 33.9%, p=0.013; 7.9% vs 14.9%, p=0.022). VH-IVUS で解析したプラーク組成 (%) に差はなく, プラーク面積およびリモデリングインデックスはACS群でSCAD群より大であった (14.7 ± 5.1 mm2 vs 12.0 ± 4.5 mm2, p<0.001; 1.15 ± 0.23 vs 1.09 ± 0.24, p=0.012). ACSを目的変数とした多重ロジスティック回帰分析を行ったところ, HDL-C (オッズ比: OR=0.965, p=0.002), スタチン内服 (OR=0.261, p<0.001), リモデリングインデックス (OR=3.093, p=0.044) がACS発症に関連する因子となった.【結論】ACSまたはSCAD発症の差異に関連する因子はHDL-C, スタチン内服および冠動脈リモデリングであった. |
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AbstractList | 【目的】急性冠症候群 (ACS) または安定冠動脈疾患 (SCAD) 患者の背景ならびに経皮的冠動脈インターベンション (PCI) 対象責任病変の特徴を比較することで,ACSならびにSCAD発症病態の差異に関連する因子を探索すること.【方法】血管内超音波 (IVUS) ガイド下でPCIを行った連続 513名 (ACS 392名,SCAD 121名) を対象とし,背景因子,冠危険因子,内服薬,冠動脈造影所見について調査し,冠動脈責任病変のプラーク面積,冠動脈プラーク組成をVirtual Histology IVUS (VH-IVUS) を用いて解析した.これらの変数をACS群とSCAD群間で比較したのち,ACSを目的変数とした多重ロジスティック回帰分析を行った.【結果】HDLコレステロール (high density lipoprotein cholesterol: HDL-C) はACS群でSCAD群より低く (43.5 ± 13.1 mg/dl vs 48.1 ± 18.1 mg/dl, p=0.002), スタチン, アンジオテンシン変換酵素阻害薬 (ACEI) またはアンジオテンシンII受容体拮抗薬 (ARB) およびβ遮断薬内服が低率であった (12.8% vs 36.4%, p<0.001; 22.7% vs 33.9%, p=0.013; 7.9% vs 14.9%, p=0.022). VH-IVUS で解析したプラーク組成 (%) に差はなく, プラーク面積およびリモデリングインデックスはACS群でSCAD群より大であった (14.7 ± 5.1 mm2 vs 12.0 ± 4.5 mm2, p<0.001; 1.15 ± 0.23 vs 1.09 ± 0.24, p=0.012). ACSを目的変数とした多重ロジスティック回帰分析を行ったところ, HDL-C (オッズ比: OR=0.965, p=0.002), スタチン内服 (OR=0.261, p<0.001), リモデリングインデックス (OR=3.093, p=0.044) がACS発症に関連する因子となった.【結論】ACSまたはSCAD発症の差異に関連する因子はHDL-C, スタチン内服および冠動脈リモデリングであった. |
Author | 安藤, 敏行 西岡, 利彦 佐々木, 英樹 中東, 威 外山, 堅太郎 中村, 嘉宏 塚田, 俊一 一色, 亜美 高鳥, 仁孝 井口, 貴文 伊藤, 博之 吉本, 信雄 佐々木, 修 神山, 哲男 井上, 芳郎 山口, 隆太郎 桐村, 正人 中田, 貴彬 |
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References | 10) Schoenhagen P, Ziada KM, Kapadia SR, et al: Extent and direction of arterial remodeling in stable versus unstable coronary syndromes: an intravascular ultrasound study. Circulation 2000; 101: 598-603 15) Luc G, Bard JM, Ferrières J, et al: Value of HDL cholesterol, apolipoprotein A-I, lipoprotein A-I, and lipoprotein A-I/A-II in prediction of coronary heart disease: the PRIME Study. Prospective Epidemiological Study of Myocardial Infarction. Arterioscler Thromb Vasc Biol 2002; 22: 1155-1161 27) Liu PY, Liu YW, Lin LJ, et al: Evidence for statin pleiotropy in humans: Differential effects of statins and ezetimibe on Rho-associated coiled-coil containing protein kinase activity, endothelial function, and inflammation. Circulation 2009; 119: 131-138 21) Boden WE: High-density lipoprotein cholesterol as an independent risk factor in cardiovascular disease: assessing the data from Framingham to the Veterans Affairs High-Density Lipoprotein Intervention Trial. Am J Cardiol 2000; 86 suppl: 19L-22L 3) Downs JR, Clearfield M, Weis S, et al: Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS. AirForce/Texas Coronary Atherosclerosis Prevention Study. JAMA 1998; 279: 1615-1622 23) von Birgelen C, Hartmann M, Mintz GS, et al: Relation between progression and regression of atherosclerotic left main coronary artery disease and serum cholesterol levels as assessed with serial long-term (> or = 12 months) follow-up intravascular ultrasound. Circulation 2003; 108: 2757-2762 28) Robinson JG, Smith B, Maheshwari N, et al: Pleiotropic effects of statins: benefit beyond cholesterol reduction? A meta-regression analysis. J Am Coll Cardiol 2005; 46: 1855-1862 12) Mintz GS, Nissen SE, Anderson WD, et al: American College of Cardiology Clinical Expert Consensus Document on Standards for Acquisition, Measurement and Reporting of Intravascular Ultrasound Studies (IVUS). J Am Coll Cardiol 2001; 37: 1478-1492 18) Zhang B, Saku K, Ohta T: In Vivo metabolism of HDL, apo-A-I, and lp A-I, and function of HDL-a clinical perspective. J Atheroscler Thromb 2000; 7: 59-66 20) Gordon DJ, Probstfield JL, Garrison RJ, et al: High-density lipoprotein cholesterol and cardiovascular disease. Four prospective American studies. Circulation 1989; 79: 8-15 5) Shepherd J, Cobbe SM, Ford I, et al: Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group. N Engl J Med 1995; 333: 1301-1307 11) Hsia J, Aragaki A, Bloch M, et al: WHI Investigators. Predictors of angina pectoris versus myocardial infarction from the Women’s Health Initiative Observational Study. Am J Cardiol 2004; 93: 673-678 24) Vaughan CJ, Gotto AM Jr, Basson CT: The evolving role of statins in the management of atherosclerosis. J Am Coll Cardiol 2000; 35: 1-10 1) Pedersen TR, Kjekshus J, Berg K, et al: Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994; 344: 1383-1389 32) Thim T, Hagensen MK, Wallace-Bradley D, et al: Unreliable assessment of necrotic core by virtual histology intravascular ultrasound in porcine coronary artery disease. Circ Cardiovasc Imaging 2010; 3: 384-391 2) Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group: Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998; 339: 1349-1357 31) Brugaletta S, Cola C, Martin-Yuste V, et al: Qualitative and quantitative accuracy of ultrasound-based virtual histology for detection of necrotic core in human coronary arteries. Int J Cardiovasc Imaging 2014; 30: 469-476 6) Akosah KO, Cerniglia RM, Havlik P, et al: Myocardial infarction in young adults with low-density lipoprotein cholesterol levels < 100 mg/dL: clinical profile and 1-year outcomes. Chest 2001; 120: 1953-1958 7) Akosah KO, Schaper A, Cogbill C, et al: Preventing myocardial infarction in the young adult in the first place: how do the National Cholesterol Education Panel III guidelines perform? J Am Coll Cardiol 2003; 41: 14751479 14) Gordon T, Castelli WP, Hjortland MC, et al: High density lipoprotein as a protective factor against coronary heart disease. The Framingham Study. Am J Med 1977; 62: 707-714 13) Smits PC, Pasterkamp G, Quarles van Ufford MA, et al: Coronary artery disease: arterial remodelling and clinical presentation. Heart 1999; 82: 461-464 29) Schoenhagen P, Tuzcu EM, Apperson-Hansen C, et al: Determinants of arterial wall remodeling during lipid-lowering therapy: serial intravascular ultrasound observations from the Reversal of Atherosclerosis with Aggressive Lipid Lowering Therapy (REVERSAL) Trial. Circulation 2006; 113: 2826-2834 25) Zhou Q, Liao JK: Pleiotropic effects of statins -Basic Research and clinical perspectives-. Circ J 2010; 74: 818-826 30) van Velzen JE, de Graaf FR, Jukema JW, et al: Comparison of the relation between the calcium score and plaque characteristics in patients with acute coronary syndrome versus patients with stable coronary artery disease, assessed by computed tomography angiography and virtual histology intravascular ultrasound. Am J Cardiol 2011; 108: 658-664 22) Gotto AM, Brinton EA: Assessing low levels of high-density lipoprotein cholesterol as a risk factor in coronary heart disease: a working group report and update. J Am Coll Cardiol 2004; 43: 717-724 19) Barter PJ, Nicholls S, Rye KA, et al: Antiinflammatory properties of HDL. Circ Res 2004; 95: 764-772 26) Landmesser U, Bahlmann F, Mueller M, et al: Simvastatin versus ezetimibe: pleiotropic and lipid-lowering effects on endothelial function in humans. Circulation 2005; 111: 2356-2363 9) Nishioka T, Luo H, Eigler NL, et al: Contribution of inadequate compensatory enlargement to development of human coronary artery stenosis: an in vivo intravascular ultrasound study. J Am Coll Cardiol 1996; 27: 1571-1576 4) Sacks FM, Pfeffer MA, Moye LA, et al: The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial Investigators. N Engl J Med 1996; 335: 1001-1009 8) Nakamura M, Nishikawa H, Mukai S, et al: Impact of coronary artery remodeling on clinical presentation of coronary artery disease: an intravascular ultrasound study. J Am Coll Cardiol 2001; 37: 63-69 17) Spieker LE, Sudano I, Hürlimann D, et al: High-density lipoprotein restores endothelial function in hypercholesterolemic men. Circulation 2002; 105: 1399-1402 16) Okamura T, Hayakawa T, Kadowaki T, et al: The NIPPON DATA 90 Research Group: The inverse relationship between serum high-density lipoprotein cholesterol level and all-cause mortality in a 9.6-year follow-up study in the Japanese general population. Atherosclerosis 2006; 184: 143-150 |
References_xml | – reference: 30) van Velzen JE, de Graaf FR, Jukema JW, et al: Comparison of the relation between the calcium score and plaque characteristics in patients with acute coronary syndrome versus patients with stable coronary artery disease, assessed by computed tomography angiography and virtual histology intravascular ultrasound. Am J Cardiol 2011; 108: 658-664 – reference: 11) Hsia J, Aragaki A, Bloch M, et al: WHI Investigators. Predictors of angina pectoris versus myocardial infarction from the Women’s Health Initiative Observational Study. Am J Cardiol 2004; 93: 673-678 – reference: 2) Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group: Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998; 339: 1349-1357 – reference: 20) Gordon DJ, Probstfield JL, Garrison RJ, et al: High-density lipoprotein cholesterol and cardiovascular disease. Four prospective American studies. Circulation 1989; 79: 8-15 – reference: 16) Okamura T, Hayakawa T, Kadowaki T, et al: The NIPPON DATA 90 Research Group: The inverse relationship between serum high-density lipoprotein cholesterol level and all-cause mortality in a 9.6-year follow-up study in the Japanese general population. Atherosclerosis 2006; 184: 143-150 – reference: 7) Akosah KO, Schaper A, Cogbill C, et al: Preventing myocardial infarction in the young adult in the first place: how do the National Cholesterol Education Panel III guidelines perform? J Am Coll Cardiol 2003; 41: 14751479 – reference: 23) von Birgelen C, Hartmann M, Mintz GS, et al: Relation between progression and regression of atherosclerotic left main coronary artery disease and serum cholesterol levels as assessed with serial long-term (> or = 12 months) follow-up intravascular ultrasound. Circulation 2003; 108: 2757-2762 – reference: 27) Liu PY, Liu YW, Lin LJ, et al: Evidence for statin pleiotropy in humans: Differential effects of statins and ezetimibe on Rho-associated coiled-coil containing protein kinase activity, endothelial function, and inflammation. Circulation 2009; 119: 131-138 – reference: 3) Downs JR, Clearfield M, Weis S, et al: Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS. AirForce/Texas Coronary Atherosclerosis Prevention Study. JAMA 1998; 279: 1615-1622 – reference: 24) Vaughan CJ, Gotto AM Jr, Basson CT: The evolving role of statins in the management of atherosclerosis. J Am Coll Cardiol 2000; 35: 1-10 – reference: 17) Spieker LE, Sudano I, Hürlimann D, et al: High-density lipoprotein restores endothelial function in hypercholesterolemic men. Circulation 2002; 105: 1399-1402 – reference: 14) Gordon T, Castelli WP, Hjortland MC, et al: High density lipoprotein as a protective factor against coronary heart disease. The Framingham Study. Am J Med 1977; 62: 707-714 – reference: 19) Barter PJ, Nicholls S, Rye KA, et al: Antiinflammatory properties of HDL. Circ Res 2004; 95: 764-772 – reference: 26) Landmesser U, Bahlmann F, Mueller M, et al: Simvastatin versus ezetimibe: pleiotropic and lipid-lowering effects on endothelial function in humans. Circulation 2005; 111: 2356-2363 – reference: 31) Brugaletta S, Cola C, Martin-Yuste V, et al: Qualitative and quantitative accuracy of ultrasound-based virtual histology for detection of necrotic core in human coronary arteries. Int J Cardiovasc Imaging 2014; 30: 469-476 – reference: 28) Robinson JG, Smith B, Maheshwari N, et al: Pleiotropic effects of statins: benefit beyond cholesterol reduction? A meta-regression analysis. J Am Coll Cardiol 2005; 46: 1855-1862 – reference: 9) Nishioka T, Luo H, Eigler NL, et al: Contribution of inadequate compensatory enlargement to development of human coronary artery stenosis: an in vivo intravascular ultrasound study. J Am Coll Cardiol 1996; 27: 1571-1576 – reference: 8) Nakamura M, Nishikawa H, Mukai S, et al: Impact of coronary artery remodeling on clinical presentation of coronary artery disease: an intravascular ultrasound study. J Am Coll Cardiol 2001; 37: 63-69 – reference: 12) Mintz GS, Nissen SE, Anderson WD, et al: American College of Cardiology Clinical Expert Consensus Document on Standards for Acquisition, Measurement and Reporting of Intravascular Ultrasound Studies (IVUS). J Am Coll Cardiol 2001; 37: 1478-1492 – reference: 13) Smits PC, Pasterkamp G, Quarles van Ufford MA, et al: Coronary artery disease: arterial remodelling and clinical presentation. Heart 1999; 82: 461-464 – reference: 6) Akosah KO, Cerniglia RM, Havlik P, et al: Myocardial infarction in young adults with low-density lipoprotein cholesterol levels < 100 mg/dL: clinical profile and 1-year outcomes. Chest 2001; 120: 1953-1958 – reference: 15) Luc G, Bard JM, Ferrières J, et al: Value of HDL cholesterol, apolipoprotein A-I, lipoprotein A-I, and lipoprotein A-I/A-II in prediction of coronary heart disease: the PRIME Study. Prospective Epidemiological Study of Myocardial Infarction. Arterioscler Thromb Vasc Biol 2002; 22: 1155-1161 – reference: 10) Schoenhagen P, Ziada KM, Kapadia SR, et al: Extent and direction of arterial remodeling in stable versus unstable coronary syndromes: an intravascular ultrasound study. Circulation 2000; 101: 598-603 – reference: 22) Gotto AM, Brinton EA: Assessing low levels of high-density lipoprotein cholesterol as a risk factor in coronary heart disease: a working group report and update. J Am Coll Cardiol 2004; 43: 717-724 – reference: 32) Thim T, Hagensen MK, Wallace-Bradley D, et al: Unreliable assessment of necrotic core by virtual histology intravascular ultrasound in porcine coronary artery disease. Circ Cardiovasc Imaging 2010; 3: 384-391 – reference: 18) Zhang B, Saku K, Ohta T: In Vivo metabolism of HDL, apo-A-I, and lp A-I, and function of HDL-a clinical perspective. J Atheroscler Thromb 2000; 7: 59-66 – reference: 4) Sacks FM, Pfeffer MA, Moye LA, et al: The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial Investigators. N Engl J Med 1996; 335: 1001-1009 – reference: 5) Shepherd J, Cobbe SM, Ford I, et al: Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group. N Engl J Med 1995; 333: 1301-1307 – reference: 21) Boden WE: High-density lipoprotein cholesterol as an independent risk factor in cardiovascular disease: assessing the data from Framingham to the Veterans Affairs High-Density Lipoprotein Intervention Trial. Am J Cardiol 2000; 86 suppl: 19L-22L – reference: 29) Schoenhagen P, Tuzcu EM, Apperson-Hansen C, et al: Determinants of arterial wall remodeling during lipid-lowering therapy: serial intravascular ultrasound observations from the Reversal of Atherosclerosis with Aggressive Lipid Lowering Therapy (REVERSAL) Trial. Circulation 2006; 113: 2826-2834 – reference: 25) Zhou Q, Liao JK: Pleiotropic effects of statins -Basic Research and clinical perspectives-. Circ J 2010; 74: 818-826 – reference: 1) Pedersen TR, Kjekshus J, Berg K, et al: Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994; 344: 1383-1389 |
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Snippet | 【目的】急性冠症候群 (ACS) または安定冠動脈疾患 (SCAD) 患者の背景ならびに経皮的冠動脈インターベンション (PCI) 対象責任病変の特徴を比較することで,ACSならびにSCAD... |
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Title | 急性冠症候群または安定冠動脈疾患発症の差異に関連する因子についての検討 |
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ispartofPNX | 日本冠疾患学会雑誌, 2016, Vol.22(3), pp.139-144 |
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