Relation Between High-Sensitivity C-Reactive Protein and Coronary Plaque Components in Patients With Acute Coronary Syndrome: Virtual Histology-Intravascular Ultrasound Analysis

Abstract

Background and ObjectivesWe used virtual histology-intravascular ultrasound (VH-IVUS) to evaluate the relationship between high-sensitivity C-reactive protein (hs-CRP) levels and plaque components in 279 acute coronary syndrome (ACS) patients.Subjects and MethodsWe divided patients into three groups according to their hs-CRP levels {lowest tertile <0.07 mg/dL (n=93), middle tertile ≥0.07, <0.4 mg/dL (n=93), and highest tertile ≥0.4 mg/dL (n=93)}. Thin-cap fibroatheroma (TCFA) was defined as focal, necrotic core (NC)-rich (≥10% of the cross-sectional area) plaques in contact with the lumen in a plaque burden ≥40%.ResultsThe highest tertile group was mostly diabetics (20%, 27%, 40%, p=0.009), and had the greatest plaque plus media volume (163±139/mm3 vs. 201±155/mm3 vs. 232±176/mm3, p=0.013). The highest tertile group had the greatest absolute and % NC volumes (13.6±15.1 mm3 vs. 14.8±14.2 mm3 vs. 23.7±24.3 mm3, p<0.001, and 14.9±8.7% vs. 16.0±8.7% vs. 19.5±10.2%, p=0.024, respectively). The culprit lesion TCFA was observed most frequently in the highest tertile group (28% vs. 35% vs. 55%, p=0.006). By multivariable analysis, absolute NC volume was an independent predictor of hs-CRP elevation {odds ratio (OR); 1.03, 95% confidence interval (CI)=1.06-1.21, p=0.004}, and hs-CRP was an independent predictor of TCFA (OR; 1.86, 95% CI=1.11-2.90, p=0.010).ConclusionVH-IVUS analysis has demonstrated that ACS patients with elevated hs-CRP have more vulnerable plaque component (NC-rich plaques and higher frequency of culprit lesion TCFA), compared with ACS patients with normal hs-CRP.

Comparison of morphologic findings obtained by optical coherence tomography in acute coronary syndrome caused by vasospasm and chronic stable variant angina

“…The authors also reported that lipid-rich plaques and TCFA were more frequent in ACS plaques. The finding that hs-CRP and cardiac troponin-I levels were elevated in the patients in the ACS group, who showed frequent intimal erosion and tear, is in close agreement with previous studies [26,27] of ACS, which showed that the higher the inflammatory activity, the higher the risk of plaque rupture.…”

Morphological Findings in Typical Variant Angina Presenting as Acute Coronary Syndrome Using Optical Coherence Tomography

“…Despite the small size of the complex lesions of relatively low thrombogenic potential, the intraluminal microthrombi observed in 6 of our patients are one of the characteristics of the pathobiological processes underlying ACS. The finding that hs‐CRP and cardiac troponin‐I levels were elevated in patients with intimal tears is consistent with previous studies of ACS, which showed that the higher the inflammatory activity, the higher the risk of plaque rupture. In our analysis of intimal erosion and intimal thrombi, we also found that the presence of intimal thrombi in OCT was associated with higher levels of hs‐CRP (Fig.…”

The Impact of Ischemic Time on the Predictive Value of High-Sensitivity C-Reactive Protein in ST-Segment Elevation Myocardial Infarction Patients Treated by Primary Percutaneous Coronary Intervention

“…Although the pathogenic role of hs-CRP in acute coronary syndrome is not well established, some studies have suggested that the chronic inflammation of the arterial wall may play an important role in plaque rupture and following thrombus formation, and these results revealed an association between hs-CRP and the incidence of acute coronary syndrome. 13 - 16) Hong et al 17) demonstrated that acute coronary syndrome patients with an elevated level of hs-CRP have more vulnerable plaque and a higher frequency of culprit lesions than acute coronary syndrome patients with a normal hs-CPR level. Additionally, other studies have found that hs-CRP had an adverse effect on patients with MI via the mechanism mediated by the interaction with a complement.…”