急性冠症候群の病態における季節的変動

Seasonal Variations in the Pathogenesis of Acute Coronary Syndromes.

• Osamu Kurihara
• Masamichi Takano
• Erika Yamamoto
• Taishi Yonetsu
• Tsunekazu Kakuta
• Tsunenari Soeda
• Bryan P Yan
• Filippo Crea
• Takumi Higuma
• Shigeki Kimura
• Yoshiyasu Minami
• Tom Adriaenssens
• Niklas F Boeder
• Holger M Nef
• Chong Jin Kim
• Vikas Thondapu
• Hyung Oh Kim
• Michele Russo
• Tomoyo Sugiyama
• Francesco Fracassi
• Hang Lee
• Kyoichi Mizuno
• Ik-Kyung Jang

抄録

背景 急性冠症候群（ACS）の季節的変動が報告されており、発生率と死亡率は冬にピークを迎える。しかし、これらの変動の根本的な病態生理はまだ推測の域を出ていない。方法と結果 光コヒーレンス断層撮影を受けたACS患者を6カ国から募集した。最も一般的な3つの病態（プラーク破裂、プラーク浸食、石灰化プラーク）の有病率を4シーズン間で比較した。ACS患者1113人（男性885人，平均年齢65.8±11.6歳）のプラーク破裂，プラーク侵食，石灰化プラークの有病率は，春50％，39％，11％，夏44％，43％，13％，秋49％，39％，12％，冬57％，30％，13％であった（＝0.039）．年齢、性、およびその他の冠動脈リスク因子を調整した後、冬は基準となる夏と比較して、プラーク破裂リスクの増加（オッズ比[OR]、1.652；95％CI、1.157～2.359；=0.006）およびプラーク浸食リスクの減少（OR、0.623；95％CI、0.429～0.905；=0.013）と有意に関連していた。破裂した患者では、高血圧の有病率は冬に有意に高かった（=0.010）が、他の2群では有意差は認められなかった。結論 ACSの発生率の季節的変動は、基礎となる病態の違いを反映している。プラーク破裂の割合は冬に最も高く、プラーク浸食の割合は夏に最も高い。ACSの予防・治療には、発生時期によって異なるアプローチが必要と考えられる。登録URL： ​。固有識別子。NCT03479723.

Background Seasonal variations in acute coronary syndromes (ACS) have been reported, with incidence and mortality peaking in the winter. However, the underlying pathophysiology for these variations remain speculative. Methods and Results Patients with ACS who underwent optical coherence tomography were recruited from 6 countries. The prevalence of the 3 most common pathologies (plaque rupture, plaque erosion, and calcified plaque) were compared between the 4 seasons. In 1113 patients with ACS (885 male; mean age, 65.8±11.6 years), the rates of plaque rupture, plaque erosion, and calcified plaque were 50%, 39%, and 11% in spring; 44%, 43%, and 13% in summer; 49%, 39%, and 12% in autumn; and 57%, 30%, and 13% in winter (=0.039). After adjusting for age, sex, and other coronary risk factors, winter was significantly associated with increased risk of plaque rupture (odds ratio [OR], 1.652; 95% CI, 1.157-2.359; =0.006) and decreased risk of plaque erosion (OR, 0.623; 95% CI, 0.429-0.905; =0.013), compared with summer as a reference. Among patients with rupture, the prevalence of hypertension was significantly higher in winter (=0.010), whereas no significant difference was observed in the other 2 groups. Conclusions Seasonal variations in the incidence of ACS reflect differences in the underlying pathobiology. The proportion of plaque rupture is highest in winter, whereas that of plaque erosion is highest in summer. A different approach may be needed for the prevention and treatment of ACS depending on the season of its occurrence. Registration URL: https://www.clini​caltr​ials.gov. Unique identifier: NCT03479723.