Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Fondazione Policlinico Agostino Gemelli - IRCCS, Rome, Italy.
Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Fondazione Policlinico Agostino Gemelli - IRCCS, Rome, Italy.
Int J Cardiol. 2019 Jul 1;286:7-12. doi: 10.1016/j.ijcard.2019.01.058. Epub 2019 Jan 18.
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.
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.
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.
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.
伴有高 C 反应蛋白（CRP）水平的急性冠状动脉综合征（ACS）患者未来发生急性缺血事件的风险更高。然而，CRP 的阳性预测值太低，无法指导特定的治疗。我们的研究旨在根据罪犯血管的光相干断层扫描（OCT）评估和 CRP 血清水平的组合，确定最有可能从抗炎治疗中获益的高危患者亚组。
从“Agostino Gemelli”医院 OCT 登记处入选因 ACS 入院并接受罪犯血管介入前 OCT 评估的患者。主要终点是复发性 ACS（re-ACS）。CRP 水平≥2mg/L 被认为异常。
总体研究人群包括 178 例患者。其中，156 例患者纳入主要终点分析。3 年随访时 re-ACS 发生率为 23%。高 CRP（2.587，95%CI：1.345-10.325，p=0.031）、斑块破裂（3.985，95%CI：1.698-8.754，p=0.009）、巨噬细胞浸润（3.145，95%CI：1.458-9.587，p=0.012）和多灶性动脉粥样硬化（2.734，95%CI：1.748-11.875，p=0.042）是 re-ACS 的独立预测因素。所有（14/14）高 CRP 且 OCT 存在所有高危特征的患者均发生 re-ACS。相反，只有 82 例低 CRP 水平且 OCT 检查无高危特征的患者中，有 4 例在随访时发生 re-ACS。
全身炎症证据与罪犯斑块的 OCT 结果相结合可识别出极高危的 ACS。需要进一步研究来证实这些发现，并在这一患者亚组中测试抗炎治疗。
