Pharmacotherapy Department, Faculty of Pharmacy, Baqiyatallah university of Medical Sciences, Tehran, Iran.
Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
Clin Biochem. 2019 Dec;74:12-18. doi: 10.1016/j.clinbiochem.2019.09.001. Epub 2019 Sep 4.
To investigate the association between plasma proprotein convertase subtilisin/kexin type 9 (PCSK9) concentrations, current acute coronary syndrome (ACS), coronary artery disease (CAD) presence, severity and extension and the burden of coronary calcifications in patients with suspected CAD.
One hundred and one patients, with or without current ACS, were recruited for this cross-sectional study. CAD presence was defined based on either the presence or absence of at least one significant (≥50%) CAD lesion (SCAD). CAD severity was classified according to the absence of coronary lesions, the presence of non-significant (<50%) CAD (MCAD) or SCAD in at least one major coronary artery. Patients with one, two or three significantly diseased major coronary arteries were defined as 1-SCAD, 2-SCAD and 3-SCAD, respectively. The cumulative length of SCAD lesions and the amount of calcifications in coronary arteries were estimated. Plasma PCSK9 concentrations were higher in patients with SCAD as compared to those without (p = .012). A significant increase in plasma PCSK9 concentrations was observed with greater CAD severity (p = .042). Higher plasma PCSK9 concentrations were found in 3-SCAD patients as compared to either 2-SCAD or 1-SCAD (p < .001). PCSK9 increased with the cumulative length of SCAD lesions and the burden of calcifications (p < .05 for both comparisons). Multivariable adjustment abolished the association between PCSK9 and either CAD presence or severity, but not the association between PCSK9 and the number of significantly diseased vessels, SCAD lesion length and the burden of coronary calcifications. ACS was associated with a borderline significant increase of plasma PCSK9 concentrations among patients not taking statins (p = .05).
Circulating PCSK9 concentrations discriminate patients with greater coronary atherosclerotic lesion extension and calcification, and are increased in patients with current ACS.
研究血浆前蛋白转化酶枯草溶菌素/柯萨奇蛋白酶 9（PCSK9）浓度与当前急性冠状动脉综合征（ACS）、冠状动脉疾病（CAD）的存在、严重程度和程度以及疑似 CAD 患者冠状动脉钙化负担之间的关系。
这项横断面研究招募了 101 名有或没有当前 ACS 的患者。CAD 的存在基于是否存在至少一个显著（≥50%）CAD 病变（SCAD）来定义。CAD 严重程度根据冠状动脉无病变、存在非显著（<50%）CAD（MCAD）或至少一条主要冠状动脉存在 SCAD 进行分类。患有一条、两条或三条明显病变的主要冠状动脉的患者分别定义为 1-SCAD、2-SCAD 和 3-SCAD。估计 SCAD 病变的累积长度和冠状动脉钙化的数量。与无 SCAD 的患者相比，SCAD 患者的血浆 PCSK9 浓度更高（p=0.012）。随着 CAD 严重程度的增加，血浆 PCSK9 浓度显著增加（p=0.042）。与 2-SCAD 或 1-SCAD 患者相比，3-SCAD 患者的血浆 PCSK9 浓度更高（p<0.001）。PCSK9 浓度随着 SCAD 病变累积长度和钙化负担的增加而增加（p<0.05）。多变量调整消除了 PCSK9 与 CAD 存在或严重程度之间的关联，但不能消除 PCSK9 与病变严重血管数量、SCAD 病变长度和冠状动脉钙化负担之间的关联。在未服用他汀类药物的患者中，ACS 与血浆 PCSK9 浓度的边缘显著增加相关（p=0.05）。
循环 PCSK9 浓度可区分冠状动脉粥样硬化病变扩展和钙化程度更大的患者，并在当前 ACS 患者中增加。
