Background:Acute coronary syndromes mainly result from abrupt thrombotic occlusion caused by atherosclerotic vulnerable plaques (VPs) that suddenly rupture or erosion. Fibrous cap thickness (FCT) is a major determinan...Background:Acute coronary syndromes mainly result from abrupt thrombotic occlusion caused by atherosclerotic vulnerable plaques (VPs) that suddenly rupture or erosion. Fibrous cap thickness (FCT) is a major determinant of the propensity of a VP to rupture and is recognized as a key factor. The intensive use of statins is known to have the ability to increase FCT;however, there is a risk of additional adverse effects. However, lower dose statin with ezetimibe is known to be tolerable by patients. The present study aimed to investigate the effect of intensive statin vs. low-dose stain + ezetimibe therapy on FCT, as evaluated using optical coherence tomography. Method:Patients who had VPs (minimum FCT <65 μm and lipid core >90°) and deferred from intervention in our single center from January 2014 to December 2018 were included in the trial. They were divided into the following two groups: intensive statin group (rosuvastatin 15-20 mg or atorvastatin 30-40 mg) and combination therapy group (rosuvastatin 5-10 mg or atorvastatin 10-20 mg + ezetimibe 10 mg). At the 12-month follow-up, we compared the change in the FCT (ΔFCT%) between the two groups and analyzed the association of ΔFCT% with risk factors. Fisher exact test was used for all categorical variables. Student’s t test or Mann-Whitney U-test was used for analyzing the continuous data. The relationship between ΔFCT% and risk factors was analyzed using linear regression analysis. Result:Total 53 patients were finally enrolled, including 26 patients who were in the intensive statin group and 27 who were in the combination therapy group. At the 12-month follow-up, the serum levels of total cholesterol (TC), total triglyceride, low-density lipoprotein (LDL-C), hypersensitive C-reactive protein (hs-CRP), and lipoprotein-associated phospholipase A2 (Lp-PLA2) levels were reduced in both the groups. The ΔTC%, ΔLDL-C%, and ΔLp-PLA2% were decreased further in the combination therapy group. FCT was increased in both the groups (combination treatment group vs. intensive statin group: 128.89 ± 7.64 vs. 110.19 ± 7.00 μm, t = -9.282, P < 0.001) at the 12-month follow-up. The increase in ΔFCT% was more in the combination therapy group (123.46% ± 14.05% vs. 91.14% ± 11.68%, t = -9.085, P < 0.001). Based on the multivariate linear regression analysis, only the serum Lp-PLA2 at the 12-month follow-up ( B = -0.203, t = -2.701, P = 0.010), ΔTC% ( B = -0.573, t = -2.048, P = 0.046), and Δhs-CRP% ( B = -0.302, t = -2.963, P = 0.005) showed an independent association with ΔFCT%. Conclusions:Low-dose statin combined with ezetimibe therapy maybe provide a profound and significant increase in FCT as compared to intensive statin monotherapy. The reductions in Lp-PLA2, ΔTC%, and Δhs-CRP% are independently associated with an increase in FCT.展开更多
Background:Elevated soluble growth stimulation-expressed gene 2(sST2)protein levels are associated with poor prognosis in pa-tients with myocardial infarction or heart failure.However,few studies have investigated the...Background:Elevated soluble growth stimulation-expressed gene 2(sST2)protein levels are associated with poor prognosis in pa-tients with myocardial infarction or heart failure.However,few studies have investigated the association between sST2 expression and plaque stability.This study aimed to investigate the expression of sST2 in patients with acute myocardial infarction and its predictive value for vulnerable plaque characteristics in culprit lesions.Methods:From October 2022 to December 2024,230 patients with acute myocardial infarction who underwent coronary angiography and optical coherence tomography(OCT)in(emergency)outpatient and inpatient departments of Jining No.1 People’s Hospital were se-lected as subjects of this prospective study.Based on the inclusion and exclusion criteria,203 patients were included in this study.Clinical data were analyzed.Based on the characteristics of criminal plaques detected by OCT,123 cases were divided into a thin-cap fibroatheroma(TCFA)group(60.6%)and a non–thin-cap fibroatheroma(NTCFA)group(80 cases).Serum sST2 levels were measured before surgery.Optical coherence tomography was used to observe the nature of the criminal lesions before interventional therapy.The relationship between serum sST2 levels and criminal plaque vulnerability was analyzed using a multivariable logistic regression model.Results:Serum cardiac troponin,C-reactive protein,and sST2 levels were higher in the TCFA group than those in the NTCFA group.OCT observations showed that patients in the TCFA group had many characteristics of vulnerable plaques,including macrophage aggre-gation,larger lipid radians,and thinner minimum fibrous caps.sST2 independently predicted the presence of TCFA in patients with acute myocardial infarction,with enhanced predictive accuracy when combined with C-reactive protein(area under the curve 0.837 vs.0.782 for sST2 alone,P=0.043).Conclusion:sST2 can independently predict the presence of thin cap atherosclerosis in patients with acute myocardial infarction,and when combined with C-reactive protein,its prediction accuracy is higher.展开更多
基金a grant from the Nanjing Medical Science and Technology Development Foundation,Nanjing Department of Health(No.201803008).
文摘Background:Acute coronary syndromes mainly result from abrupt thrombotic occlusion caused by atherosclerotic vulnerable plaques (VPs) that suddenly rupture or erosion. Fibrous cap thickness (FCT) is a major determinant of the propensity of a VP to rupture and is recognized as a key factor. The intensive use of statins is known to have the ability to increase FCT;however, there is a risk of additional adverse effects. However, lower dose statin with ezetimibe is known to be tolerable by patients. The present study aimed to investigate the effect of intensive statin vs. low-dose stain + ezetimibe therapy on FCT, as evaluated using optical coherence tomography. Method:Patients who had VPs (minimum FCT <65 μm and lipid core >90°) and deferred from intervention in our single center from January 2014 to December 2018 were included in the trial. They were divided into the following two groups: intensive statin group (rosuvastatin 15-20 mg or atorvastatin 30-40 mg) and combination therapy group (rosuvastatin 5-10 mg or atorvastatin 10-20 mg + ezetimibe 10 mg). At the 12-month follow-up, we compared the change in the FCT (ΔFCT%) between the two groups and analyzed the association of ΔFCT% with risk factors. Fisher exact test was used for all categorical variables. Student’s t test or Mann-Whitney U-test was used for analyzing the continuous data. The relationship between ΔFCT% and risk factors was analyzed using linear regression analysis. Result:Total 53 patients were finally enrolled, including 26 patients who were in the intensive statin group and 27 who were in the combination therapy group. At the 12-month follow-up, the serum levels of total cholesterol (TC), total triglyceride, low-density lipoprotein (LDL-C), hypersensitive C-reactive protein (hs-CRP), and lipoprotein-associated phospholipase A2 (Lp-PLA2) levels were reduced in both the groups. The ΔTC%, ΔLDL-C%, and ΔLp-PLA2% were decreased further in the combination therapy group. FCT was increased in both the groups (combination treatment group vs. intensive statin group: 128.89 ± 7.64 vs. 110.19 ± 7.00 μm, t = -9.282, P < 0.001) at the 12-month follow-up. The increase in ΔFCT% was more in the combination therapy group (123.46% ± 14.05% vs. 91.14% ± 11.68%, t = -9.085, P < 0.001). Based on the multivariate linear regression analysis, only the serum Lp-PLA2 at the 12-month follow-up ( B = -0.203, t = -2.701, P = 0.010), ΔTC% ( B = -0.573, t = -2.048, P = 0.046), and Δhs-CRP% ( B = -0.302, t = -2.963, P = 0.005) showed an independent association with ΔFCT%. Conclusions:Low-dose statin combined with ezetimibe therapy maybe provide a profound and significant increase in FCT as compared to intensive statin monotherapy. The reductions in Lp-PLA2, ΔTC%, and Δhs-CRP% are independently associated with an increase in FCT.
基金supported by the Medical and Health Science and Technology Projects in Shandong Province(202410000557)Jining Key Research and Development(2024YXNS171).
文摘Background:Elevated soluble growth stimulation-expressed gene 2(sST2)protein levels are associated with poor prognosis in pa-tients with myocardial infarction or heart failure.However,few studies have investigated the association between sST2 expression and plaque stability.This study aimed to investigate the expression of sST2 in patients with acute myocardial infarction and its predictive value for vulnerable plaque characteristics in culprit lesions.Methods:From October 2022 to December 2024,230 patients with acute myocardial infarction who underwent coronary angiography and optical coherence tomography(OCT)in(emergency)outpatient and inpatient departments of Jining No.1 People’s Hospital were se-lected as subjects of this prospective study.Based on the inclusion and exclusion criteria,203 patients were included in this study.Clinical data were analyzed.Based on the characteristics of criminal plaques detected by OCT,123 cases were divided into a thin-cap fibroatheroma(TCFA)group(60.6%)and a non–thin-cap fibroatheroma(NTCFA)group(80 cases).Serum sST2 levels were measured before surgery.Optical coherence tomography was used to observe the nature of the criminal lesions before interventional therapy.The relationship between serum sST2 levels and criminal plaque vulnerability was analyzed using a multivariable logistic regression model.Results:Serum cardiac troponin,C-reactive protein,and sST2 levels were higher in the TCFA group than those in the NTCFA group.OCT observations showed that patients in the TCFA group had many characteristics of vulnerable plaques,including macrophage aggre-gation,larger lipid radians,and thinner minimum fibrous caps.sST2 independently predicted the presence of TCFA in patients with acute myocardial infarction,with enhanced predictive accuracy when combined with C-reactive protein(area under the curve 0.837 vs.0.782 for sST2 alone,P=0.043).Conclusion:sST2 can independently predict the presence of thin cap atherosclerosis in patients with acute myocardial infarction,and when combined with C-reactive protein,its prediction accuracy is higher.
