Risk factors of atherosclerotic tissue types in single-vessel and intermediate coronary lesions: a cross-sectional study.
BACKGROUND
Few data exist that correlate lesion-related risk factors such as conventional cardiovascular risks or lipoprotein-associated phospholipase A2 (Lp-PLA2) with tissue types within atherosclerotic plaques in patients with single-vessel and intermediate coronary lesions.


METHODS
One hundred and ninety-two patients with single-vessel and intermediate coronary lesions were enrolled in a cross-sectional study and divided into two groups: stable angina pectoris (SAP) and acute coronary syndrome (ACS) groups. Data regarding clinical characteristics and Lp-PLA2 mass were collected. Using iMAP-IVUS, lumen areas were manually traced to determine the minimum lumen area (MLA) at 1-mm intervals in diseased segments. At the minimum lumen lesion, areas of different types of atherosclerotic tissue [i.e., areas of fibrous plaque tissue (FP), fibro-fatty tissue (FF), dense calcium (DC) and necrotic core (NC)], vascular external elastic membrane (EEMCSA) and plaque and media (P&MCSA) were calculated using the built-in iMap algorithm. Plaque burden was computed as P&MCSA divided by EEMCSA.


RESULTS
In a univariate analysis, glycosylated hemoglobin A1C (GHbA1C), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), hypertension, Lp-PLA2 and a history of taking statins predicted the degree of FP and NC area, as well as plaque burden, but were not significant predictors of FF or DC area. In a multivariate analysis, Lp-PLA2 and HbA1c remained independent predictors of plaque burden, FP and NC area. However, the results of the regression analyses were not identical when the SAP and ACS groups were analyzed separately. Lp-PLA2, diabetes and NC area were significant predictors of acute coronary lesions, and the predictive value of Lp-PLA2 was confirmed by the finding of a high area-under-the-curve in a ROC analysis (0.837, 95% CI:0.778-0.895, P = 0.000), as well as by the reasonable sensitivity and specificity of cut-off values.


CONCLUSIONS
GHbA1C and Lp-PLA2 were strong independent predictors of plaque burden and FP and NC area at the minimum lumen lesion in patients with single-vessel and intermediate coronary lesions. Furthermore, Lp-PLA2 has a certain predictive value for acute coronary lesions.
Department of Cardiology, the Eighty-first Hospital of PLA Affiliated with Anhui Medical University, No. 34, Biao 34, Yanggongjing, Qinhuai District, Nanjing, Jiangsu, 210000, China.
Xianjin
X
Wang
Department of Cardiology, the Eighty-first Hospital of PLA Affiliated with the Nanjing University of Chinese Medicine, Nanjing, China.
Qun
Q
Chen
Department of Cardiology, the Eighty-first Hospital of PLA Affiliated with the Nanjing University of Chinese Medicine, Nanjing, China.
Yu
Y
Xu
Department of Cardiology, the Eighty-first Hospital of PLA Affiliated with the Nanjing University of Chinese Medicine, Nanjing, China.
Yanqing
Y
Wang
Department of Cardiology, the Eighty-first Hospital of PLA Affiliated with the Nanjing University of Chinese Medicine, Nanjing, China.
Yang
Y
Yang
Department of Cardiology, the Eighty-first Hospital of PLA Affiliated with the Nanjing University of Chinese Medicine, Nanjing, China.
Ming
M
Gu
Department of Cardiology, the Eighty-first Hospital of PLA Affiliated with the Nanjing University of Chinese Medicine, Nanjing, China.
Haihua
H
Xu
Department of Cardiology, the Eighty-first Hospital of PLA Affiliated with Anhui Medical University, No. 34, Biao 34, Yanggongjing, Qinhuai District, Nanjing, Jiangsu, 210000, China. yanfangz@sina.com.|Department of Cardiology, the Eighty-first Hospital of PLA Affiliated with the Nanjing University of Chinese Medicine, Nanjing, China. yanfangz@sina.com.
Yanfang
http://orcid.org/0000-0003-0849-3789
Y
Zhao
D054058:Acute Coronary Syndrome / Q000097:blood* / Q000473:pathology; D000368:Aged; D050197:Atherosclerosis / Q000097:blood* / Q000473:pathology; D002784:Cholesterol / Q000097:blood*; D003324:Coronary Artery Disease / Q000097:blood* / Q000473:pathology; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000097:blood* / Q000473:pathology; D012372:ROC Curve; D012307:Risk Factors
D002784:Cholesterol
Arteriosclerosis; Lipoprotein-associated phospholipase A2; Ultrasonics