期刊
INTERNATIONAL JOURNAL OF CARDIOLOGY
卷 286, 期 -, 页码 7-12出版社
ELSEVIER IRELAND LTD
DOI: 10.1016/j.ijcard.2019.01.058
关键词
Acute coronary syndrome; Optical coherence tomography; Macrophage infiltration; Inflammation; Secondary prevention
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. (C) 2019 Elsevier B.V. All rights reserved.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据