Fröbert Ole, Stone Gregg W, Larsen Alf Inge, Zhou Zhipeng, Kotinkaduwa Lak N, Engstrøm Thomas, Kjøller-Hansen Lars, Maeng Michael, Matsumura Mitsuaki, Ben-Yehuda Ori, Bøtker Hans Erik, Persson Jonas, Wiseth Rune, Jensen Lisette O, Nordrehaug Jan E, Trovik Thor, Jensen Ulf, Bleie Øyvind, James Stefan K, Ali Ziad A, Omerovic Elmir, Erlinge David, Maehara Akiko
Faculty of Health, Department of Cardiology, Örebro University, Örebro, Sweden; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.
Icahn School of Medicine at Mount Sinai, New York, New York, USA.
JACC Cardiovasc Interv. 2025 May 26;18(10):1217-1228. doi: 10.1016/j.jcin.2025.01.440. Epub 2025 Apr 23.
Inflammation is a driver of atherosclerosis and susceptibility to cardiovascular events.
The authors sought to evaluate whether high-sensitivity C-reactive protein (hsCRP) levels are associated with the prevalence of high-risk coronary plaques in patients with non-ST-segment elevation myocardial infarction (NSTEMI).
PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) II was a multicenter, prospective study enrolling patients with recent myocardial infarction. Following treatment of all flow-limiting lesions, 3-vessel imaging with near-infrared spectroscopy and intravascular ultrasound was used to characterize untreated nonculprit lesions. We investigated the association between baseline hsCRP and plaque morphology (lipid content, plaque burden, lumen area) in 501 NSTEMI patients. hsCRP levels were categorized as low (<1 mg/L), intermediate (1-3 mg/L), or high (>3 mg/L).
The percentages of patients with at least 1 highly lipidic plaque (maximum lipid core burden index for any 4-mm pullback length ≥324.7) increased from 39.4% to 57.2% to 59.3% in the low, intermediate, and high hsCRP groups, respectively (P = 0.01). The proportion of patients with at least 1 highly lipidic plaque with ≥70% burden increased with hsCRP levels from 22.7% to 27.2% to 36.7%, respectively (P = 0.01). Multivariable analyses showed that increasing hsCRP was associated with higher total coronary artery lipid core burden index and plaque volume. Higher hsCRP increased the odds of having any highly lipidic plaque and those with ≥70% plaque burden.
Among patients with recent NSTEMI, a high baseline hsCRP level was associated with the presence of pan-coronary atherosclerosis and focal high-risk plaques. (PROSPECT II & PROSPECT ABSORB - an Integrated Natural History Study and Randomized Trial; NCT02171065).
炎症是动脉粥样硬化及心血管事件易感性的驱动因素。
作者旨在评估高敏C反应蛋白（hsCRP）水平是否与非ST段抬高型心肌梗死（NSTEMI）患者中高危冠状动脉斑块的患病率相关。
PROSPECT（提供区域观察以研究冠状动脉树中事件的预测因素）II是一项纳入近期心肌梗死患者的多中心前瞻性研究。在处理所有血流限制性病变后，采用近红外光谱和血管内超声进行三支血管成像，以表征未处理的非罪犯病变。我们在501例NSTEMI患者中研究了基线hsCRP与斑块形态（脂质含量、斑块负荷、管腔面积）之间的关联。hsCRP水平分为低（<1mg/L）、中（1 - 3mg/L）或高（>3mg/L）。
低、中、高hsCRP组中至少有1个高度脂质化斑块（任何4mm回撤长度的最大脂质核心负荷指数≥324.7）的患者百分比分别从39.4%增至57.2%再增至59.3%（P = 0.01）。至少有1个高度脂质化斑块且负荷≥70%的患者比例随hsCRP水平升高，分别从22.7%增至27.2%再增至36.7%（P = 0.01）。多变量分析显示，hsCRP升高与总冠状动脉脂质核心负荷指数和斑块体积增加相关。较高的hsCRP增加了有任何高度脂质化斑块以及斑块负荷≥70%的斑块的几率。
在近期NSTEMI患者中，高基线hsCRP水平与全冠状动脉粥样硬化及局灶性高危斑块的存在相关。（PROSPECT II和PROSPECT ABSORB - 一项综合自然史研究和随机试验；NCT02171065）
