title: Relationship between hs-CRP, proMMP-1, TIMP-1 and coronary plaque morphology: intravascular ultrasound study.
abstract: BACKGROUND
  Rupture of unstable plaque with subsequent thrombus formation is the common pathophysiological substrate of the acute coronary syndrome (ACS). It is of potential significance to explore the blood indexes predicting plaque characteristics. Little studies have focused on this field. Therefore we investigated the relationship between hypersensitive C-reactive protein (hs-CRP), pro-matrix metalloproteinase-1 (proMMP-1), tissue inhibitors of matrix metalloproteinase-1 (TIMP-1) and coronary plaque morphology.
  
  
  METHODS
  Intravascular ultrasound (IVUS) examination was done in 152 patients with confirmed coronary heart disease before percutaneous coronary intervention from February 2003 to July 2005. Plasma samples of arterial blood were collected prior to the procedure. The level of hs-CRP, proMMP-1 and TIMP-1 were respectively measured by enzyme-linked immunosorbent assay (ELISA).
  
  
  RESULTS
  Unstable and ruptured plaque were found more frequently in patients with acute myocardial infarction and unstable angina. External elastic membrane cross-sectional area (EEM CSA), plaque area, lipid pool area and plaque burden were significantly larger in ruptured and unstable plaque group. Positive remolding, thinner fabric-cap, smaller minimal lumen cross-sectional area (MLA), dissection and thrombus were significantly more frequent in ruptured and unstable plaque group. The levels of plasma hs-CRP, proMMP-1 and TIMP-1 were higher in ruptured plaque group. hs-CRP > 8.94 mg/L was used to predict ruptured plaque with a ROC curve area of 0.76 [95% confidence interval (CI), 67.0% - 85.8%], sensitivity of 71.8%, specificity of 77.0% and accuracy of 69.2% (P < 0.01), similarly for proMMP-1 > 0.12 ng/ml with a ROC curve area of 0.69 [95% CI, 58.2% - 80.2%], sensitivity of 69.2%, specificity of 75.2% and accuracy of 66.2% (P < 0.01), and TIMP-1 > 83.45 ng/ml with a ROC curve area of 0.67 [95% CI, 56.2% - 78.3%], sensitivity of 66.7%, specificity of 61.9% and accuracy of 66.2% (P < 0.01).
  
  
  CONCLUSIONS
  The plaque characteristics correlate with the clinical presentation. The elevation of hs-CRP, proMMP-1 and TIMP-1 are related to the plaque instability and rupture.
authors.affiliation: Department of Cardiology, Hangzhou First Municipal Hospital & Hangzhou Hospital, Nanjing Medical University, Hangzhou 310006, China.
authors.forename: Xing-wei
authors.initials: XW
authors.lastname: Zhang
authors.forename: Jun-bo
authors.initials: JB
authors.lastname: Ge
authors.forename: Jian-min
authors.initials: JM
authors.lastname: Yang
authors.forename: Lei
authors.initials: L
authors.lastname: Ge
authors.forename: Ning-fu
authors.initials: NF
authors.lastname: Wang
authors.forename: Yan
authors.initials: Y
authors.lastname: Gao
authors.forename: Pei-zhang
authors.initials: PZ
authors.lastname: Li
authors.forename: Hao
authors.initials: H
authors.lastname: Pan
authors.forename: Guo-xin
authors.initials: GX
authors.lastname: Tong
authors.forename: Liang
authors.initials: L
authors.lastname: Zhou
authors.forename: Xian-hua
authors.initials: XH
authors.lastname: Ye
authors.forename: Jian
authors.initials: J
authors.lastname: Xu
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis*; D003324:Coronary Artery Disease / Q000473:pathology; D003327:Coronary Disease / Q000097:blood / Q000473:pathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000473:pathology*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D008297:Male; D020781:Matrix Metalloproteinase 1 / Q000097:blood*; D008875:Middle Aged; D012372:ROC Curve; D019715:Tissue Inhibitor of Metalloproteinase-1 / Q000097:blood*; D018084:Ultrasonography, Interventional
chemical_list: D019715:Tissue Inhibitor of Metalloproteinase-1; D002097:C-Reactive Protein; D020781:Matrix Metalloproteinase 1