Abstract
BackgroundFew data exist that correlate lesion-related risk factors such as conventional cardiovascular risks or lipoprotein-associated phospholipase A2 (Lp-PLA2) with tissue types within atherosclerotic plaques in patients with single-vessel and intermediate coronary lesions.MethodsOne hundred and ninety-two patients with single-vessel and intermediate coronary lesions were enrolled in a cross-sectional study and divided into two groups: stable angina pectoris (SAP) and acute coronary syndrome (ACS) groups. Data regarding clinical characteristics and Lp-PLA2 mass were collected. Using iMAP-IVUS, lumen areas were manually traced to determine the minimum lumen area (MLA) at 1-mm intervals in diseased segments. At the minimum lumen lesion, areas of different types of atherosclerotic tissue [i.e., areas of fibrous plaque tissue (FP), fibro-fatty tissue (FF), dense calcium (DC) and necrotic core (NC)], vascular external elastic membrane (EEMCSA) and plaque and media (P&MCSA) were calculated using the built-in iMap algorithm. Plaque burden was computed as P&MCSA divided by EEMCSA.ResultsIn a univariate analysis, glycosylated hemoglobin A1C (GHbA1C), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), hypertension, Lp-PLA2 and a history of taking statins predicted the degree of FP and NC area, as well as plaque burden, but were not significant predictors of FF or DC area. In a multivariate analysis, Lp-PLA2 and HbA1c remained independent predictors of plaque burden, FP and NC area. However, the results of the regression analyses were not identical when the SAP and ACS groups were analyzed separately. Lp-PLA2, diabetes and NC area were significant predictors of acute coronary lesions, and the predictive value of Lp-PLA2 was confirmed by the finding of a high area-under-the-curve in a ROC analysis (0.837, 95% CI:0.778-0.895, P = 0.000), as well as by the reasonable sensitivity and specificity of cut-off values.ConclusionsGHbA1C and Lp-PLA2 were strong independent predictors of plaque burden and FP and NC area at the minimum lumen lesion in patients with single-vessel and intermediate coronary lesions. Furthermore, Lp-PLA2 has a certain predictive value for acute coronary lesions.
Highlights
Few data exist that correlate lesion-related risk factors such as conventional cardiovascular risks or lipoprotein-associated phospholipase A2 (Lp-PLA2) with tissue types within atherosclerotic plaques in patients with single-vessel and intermediate coronary lesions
Numerous previous reports have shown that the predictors of culprit or non-culprit lesionrelated major adverse cardiovascular events are associated with a combination of thin-cap fibroatheroma (TCFA), plaque burden ≥70%, minimum lumen area (MLA) ≤4.0 mm2, median dense calcium (DC) area ≥0.2 mm2, and median necrotic core (NC) area ≥0.4 mm2 [4,5,6]
Baseline data of the two groups The clinical characteristics are shown in Table 1; based on these, we can conclude that compared to the stable angina pectoris (SAP) group, the acute coronary syndrome (ACS) group had higher population proportions with histories of smoking and diabetes, higher low-density lipoprotein cholesterol (LDL-C) values and Lp-PLA2 masses, and lower high-density lipoprotein cholesterol (HDL-C) values
Summary
Few data exist that correlate lesion-related risk factors such as conventional cardiovascular risks or lipoprotein-associated phospholipase A2 (Lp-PLA2) with tissue types within atherosclerotic plaques in patients with single-vessel and intermediate coronary lesions. Epidemiologic data show that the relationship between conventional cardiovascular risk factors and adverse clinical events in patients with coronary disease is complex [1]. Whether established cardiovascular risk factors or Lp-PLA2 can predict different tissue types within the atherosclerotic plaque, remains unknown. The purpose of this study was to examine the relationship between conventional cardiovascular risk factors, Lp-PLA2 concentration and plaque structure parameters as assessed by intravascular ultrasound in patients with either stable angina or acute coronary syndromes due to intermediate singlevessel coronary artery lesions
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