Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China.
Department of Cardiology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Qingdao University, Yantai, China.
BMC Cardiovasc Disord. 2020 Oct 9;20(1):443. doi: 10.1186/s12872-020-01717-5.
No-reflow occurs in 3-4% of all percutaneous coronary interventions (PCIs) and has a strong negative impact on clinical outcomes of acute coronary syndrome (ACS). Therefore, the discovery of a biomarker that can early predict the occurrence of no-reflow has great clinical significance. Multiple factors including platelet activation are relevant to no-reflow. Calprotectin is found to be a biomarker of plaque instability and is identified to be a novel diagnostic and prognostic biomarker of cardiovascular diseases. The association of plasma calprotectin with platelet activation and no-reflow phenomenon in ACS is not clear.
In this prospective study performed at Yantai Yuhuangding Hospital from 2017 to 2018, a total of 176 Chinese patients with ACS who had undergone PCIs were recruited consecutively, aged from 30 to 88 years. Angiographic no-reflow was defined as thrombolysis in myocardial infarction grade less than 3. Blood samples were collected immediately at admission for the detection of plasma calprotectin and platelet-monocyte aggregates formation. Statistical analysis was performed for the variable's comparisons between groups and the prediction value of plasma calprotectin for no-reflow.
The mean age of the 176 included ACS patients were 64(±11) years and acute ST-segment elevation myocardial infarction (STEMI) was present in 41.5% of patients. Twenty-two patients had no-reflow during the PCI procedures and the prevalence was 12.5%. Patients with higher plasma calprotectin had a higher level of platelet-monocyte aggregates (PMA) and a higher prevalence of no-reflow (p < 0.001). The multivariate regression showed that plasma calprotectin and admission hs-cTnI were independently associated with PMA, while plasma calprotectin and serum LDL-c were independent predictors of no-reflow (p < 0.001 and p = 0.017). AUC of calprotectin for predicting no-reflow were 0.898. The cut-off value of plasma calprotectin for no-reflow was 4748.77 ng/mL with a sensitivity of 0.95 and a specificity of 0.77.
Plasma calprotectin was associated with platelet activation and may act as an early predictive biomarker of no-reflow in patients with acute coronary syndrome.
无复流现象在所有经皮冠状动脉介入治疗（PCI）中占 3-4%，对急性冠状动脉综合征（ACS）的临床结局有强烈的负面影响。因此，发现一种能够早期预测无复流发生的生物标志物具有重要的临床意义。血小板激活等多种因素与无复流有关。钙卫蛋白被发现是斑块不稳定的生物标志物，被认为是心血管疾病的一种新的诊断和预后生物标志物。血浆钙卫蛋白与 ACS 中血小板激活和无复流现象的关系尚不清楚。
本研究为前瞻性研究，于 2017 年至 2018 年在烟台毓璜顶医院进行，连续纳入 176 例接受 PCI 的中国 ACS 患者，年龄 30-88 岁。无复流定义为心肌梗死溶栓治疗（TIMI）血流分级<3 级。入院时立即采集血样，检测血浆钙卫蛋白和血小板-单核细胞聚集体形成情况。对组间变量比较和血浆钙卫蛋白对无复流的预测价值进行统计学分析。
176 例 ACS 患者的平均年龄为 64（±11）岁，急性 ST 段抬高型心肌梗死（STEMI）占 41.5%。22 例患者在 PCI 过程中发生无复流，发生率为 12.5%。血浆钙卫蛋白水平较高的患者血小板-单核细胞聚集体（PMA）水平较高，无复流发生率较高（p<0.001）。多变量回归显示，血浆钙卫蛋白和入院高敏肌钙蛋白 I（hs-cTnI）与 PMA 独立相关，而血浆钙卫蛋白和血清 LDL-c 是无复流的独立预测因子（p<0.001 和 p=0.017）。钙卫蛋白预测无复流的 AUC 为 0.898。血浆钙卫蛋白预测无复流的截断值为 4748.77ng/ml，敏感性为 0.95，特异性为 0.77。
血浆钙卫蛋白与血小板激活有关，可能是急性冠状动脉综合征患者无复流的早期预测生物标志物。
