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Optical coherence tomography and C-reactive protein in risk stratification of acute coronary syndromes

2019; Elsevier BV; Volume: 286; Linguagem: Inglês

10.1016/j.ijcard.2019.01.058

1874-1754

Francesco Fracassi, Giampaolo Niccoli, Vincenzo Vetrugno, Michele Russo, Francesco Rettura, Federico Vergni, Giancarla Scalone, Rocco Antonio Montone, Rocco Vergallo, Domenico D’Amario, Giovanna Liuzzo, Filippo Crea,

Cardiac Imaging and Diagnostics

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.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.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.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.