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Optical coherence tomography and C-reactive protein in risk stratification of acute coronary syndromes.

Abstract：

BACKGROUND:Patients with acute coronary syndrome (ACS) associated to high C-reactive protein (CRP) levels exhibit a higher risk of future acute ischemic events. Yet, the positive predictive value of CRP is too low to guide a specific treatment. Our study aims to identify a high-risk patient subset who might mostly benefit from anti-inflammatory treatment on the basis of the combination of optical coherence tomography (OCT) assessment of the culprit vessel and CRP serum levels. METHODS:Patients admitted for ACS and undergoing pre-interventional OCT assessment of the culprit vessel were selected from "Agostino Gemelli" Hospital OCT Registry. The primary end-point was recurrent ACS (re-ACS). CRP levels ≥2 mg/L were considered abnormal. RESULTS:The overall study population consisted of 178 patients. Among these, 156 patients were included in the primary end-point analysis. The re-ACS rate was 23% at 3-year follow-up. High CRP (2.587, 95% CI:1.345-10.325, p = 0.031), plaque rupture (3.985, 95% CI:1.698-8.754, p = 0.009), macrophage infiltration (3.145, 95% CI:1.458-9.587, p = 0.012) and multifocal atherosclerosis (2.734, 95% CI:1.748-11.875, p = 0.042) were independent predictors of re-ACS. All patients (14/14) with high CRP and with all OCT high-risk features had re-ACS. At the other extreme, only 4 of the 82 patients with low CRP levels and lack of high-risk features at OCT examination exhibited re-ACS at follow-up. CONCLUSIONS:The combination of systemic evidence of inflammation and OCT findings in the culprit plaque identifies very high-risk ACS. Future studies are warranted to confirm these findings and to test an anti-inflammatory treatment in this patient subset.

journal_name

Int J Cardiol

journal_title

International journal of cardiology

authors

Fracassi F,Niccoli G,Vetrugno V,Russo M,Rettura F,Vergni F,Scalone G,Montone RA,Vergallo R,D'Amario D,Liuzzo G,Crea F

doi

10.1016/j.ijcard.2019.01.058

subject

Has Abstract

pub_date

2019-07-01 00:00:00

pages

7-12

eissn

0167-5273

issn

1874-1754

pii

S0167-5273(18)36900-6

journal_volume

286

pub_type

杂志文章

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