Lipoprotein-Associated Phospholipase A2 in Cardiovascular Risk Stratification After Coronary Angioplasty in Patients With Type 2 Diabetes: Which Decision Rule Threshold to Choose?

Abstract

The research objective is to determine the posterior probability of adverse cardiovascular events after elective coronary intervention in patients with ischemic heart disease (IHD) associated with type 2 diabetes, at high level of lipoprotein-associated phospholipase A2 (Lp-PLA2) in blood serum, as well as to find out the optimal separation point value for this predictor, which increase allows to identify high risk with accuracy.Material and methods. The 12-month cohort observational study included 60 patients (78% of men and 22% of women) with IHD associated with type 2 diabetes, aged 48–78. At the beginning of the study, along with conventional diagnostic techniques typical of a specialized cardiology clinic, the state of carbohydrate and lipid metabolism was analyzed and the proinflammatory status was evaluated (including assessment of Lp-PLA2 concentration by ELISA). At the end of the study distant results of treatment were assessed. The following events were taken into account: death of cardiovascular events, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization (surgical, endovascular) due to restricture formation of a primary implanted stent or stricture formation of native coronary arteries, angina pectoris relapses.Results and discussion. The link between adverse cardiovascular events after elective percutaneous coronary intervention in patients with IHD type 2 diabetes-associated and high concentration of Lp-PLA2 in blood serum has been identified. Variation of the decision rule threshold on the performance curve has allowed to take Lp-PLA2 concentration of 983 ng/ml as a separation point. Accuracy of twoclass classification (determination of the posterior probability of adverse cardiovascular events) after identifying such separation point was characterized by 80% sensitivity and 100% specificity.Conclusion. The increase in the Lp-PLA2 concentration in blood serum (>983 ng/ml) may be considered as a predictor of adverse cardiovascular events after elective percutaneous coronary intervention in patients with IHD associated with type 2 diabetes.

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