Нестабильные атеросклеротические бляшки коронарных артерий при стабильной ишемической болезни сердца: 12-месячное наблюдение

Relevance. A key objective of modern cardiology is the assessment of acute coronary syndrome (ACS) risk in patients with coronary artery disease (CAD) to develop preventive measures and choose optimal treatment strategies. Objective. Detect vulnerable plaques of non-target coronary arteries in patients with stable CAD during routine percutaneous coronary intervention using virtual-histology intravascular ultrasound (VH-IVUS) and view their morphology over time. Materials and Methods.  The prospective observational cohort study included 58 patients with stable CAD. After stenting of a target vessel, VH-IVUS was carried out in proximal and middle segments (6–8 cm) of a non-target coronary artery with no significant stenosis according to coronary angiography. Twelve months later, all patients underwent coronary angiography with re-IVUS of previously detected lesions. Death, myocardial infarction, rehospitalization, and unplanned myocardial revascularization due to vulnerable plaques were the endpoints of the study. Results. IVUS with virtual histology revealed 58 lesions of non-target coronary arteries in 56 (96.5 %) patients. Two patients had no lesions in non-target coronary arteries. A large necrotic core with thin cap (thin-cap fibroatheroma) was detected in 12 (20.7 %) plaques, six of which had additional ACS risk criteria (stenosis area >70 % and / or lumen area <4 mm2). Within the 12‑month follow-up period, three patients (one with a vulnerable plaque in IVUS) were hospitalized with a clinical picture of ACS. One cardiac death was registered in a patient with the IVUS vulnerable plaque. 7 of 12 vulnerable plaques stabilized in 12 months. Conclusion. 1) The data presented indicate a high rate (20.7 %) of vulnerable plaques of non-target coronary arteries in patients with stable CAD who underwent stenting; 2) Two (16.6 %) patients with vulnerable plaques reached endpoints (death and rehospitalization) within the 12‑month follow-up period; 3) An analysis of atherosclerotic plaques in non-target coronary arteries over time showed that vulnerable plaques stabilized and did not cause ACS in more than half of cases (7 of 12); 4) Plaques that were not vulnerable according to IVUS were not likely to destabilize within the 12‑month follow-up period.