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Plaque characteristics and inflammatory markers for the prediction of major cardiovascular events in patients with ST-segment elevation myocardial infarction

  • Ae-Young Her
  • Kyoung Im Cho
  • Gillian Balbir Singh
  • Dae Seong An
  • Young-Hoon Jeong
  • Bon-Kwon Koo
  • Eun-Seok Shin
Original Paper

Abstract

To investigate the clinical utility of culprit plaque characteristics and inflammatory markers for the prediction of future cardiovascular events in patients with ST-segment elevation myocardial infarction (STEMI) with successful drug-eluting stent (DES) implantation. We evaluated 172 STEMI patients with successful primary percutaneous coronary intervention (PCI) with DES using pre-PCI high-sensitivity C-reactive protein (hs-CRP), neutrophil-to-lymphocyte ratio (NLR) and pre-PCI intravascular ultrasound virtual histology (IVUS-VH) of culprit lesions. The incidence of major adverse cardiovascular events (MACE) including all-cause mortality, non-fatal MI, stroke and late revascularization were recorded during hospitalization and follow-up. During follow-up (median 41 months), the incidence of MACE did not significantly differ among patients with or without all 3 high-risk plaque features on IVUS-VH (15.1 vs. 16.2%; p = 0.39). In contrast, patients with elevated hs-CRP and NLR levels were at significant risk for MACE [32.7 vs. 5.8%; hazard ratio (HR) 7.85; p < 0.001 and 43.9 vs. 6.9%; HR 8.44; p < 0.001, respectively]. High-risk plaque features had no incremental usefulness to predict future MACE. However, the incorporation of hs-CRP and NLR into a model with conventional clinical and procedural risk factors significantly improved the C-statistic for the prediction of MACE (0.76–0.89; p = 0.04). High-risk plaque features identified by IVUS-VH in culprit lesions were not associated with future MACE in patients with STEMI receiving DES. However, elevated hs-CRP and NLR levels were significantly associated with poorer outcomes and had incremental predictive values over conventional risk factors.

Keywords

Plaque characteristics High-sensitivity C-reactive protein Neutrophil to lymphocyte ratio Intravascular ultrasound virtual histology ST-segment elevation myocardial infarction Outcomes 

Abbreviations

AMI

Acute myocardial infarction

DES

Drug-eluting stent

hs-CRP

High sensitivity C-reactive protein

IVUS-VH

Intravascular ultrasound virtual histology

MACE

Major adverse cardiovascular events

NLR

Neutrophil to lymphocyte ratio

PCI

Percutaneous coronary intervention

STEMI

ST-segment elevation myocardial infarction

TCFA

Thin-cap fibroatheroma

Notes

Compliance with ethical standards

Conflict of interest

The author(s) declare that they have no competing interests.

Supplementary material

10554_2017_1135_MOESM1_ESM.docx (15 kb)
Supplementary material 1 (DOCX 14 KB)

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Copyright information

© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  • Ae-Young Her
    • 1
  • Kyoung Im Cho
    • 2
  • Gillian Balbir Singh
    • 3
  • Dae Seong An
    • 4
  • Young-Hoon Jeong
    • 5
  • Bon-Kwon Koo
    • 6
  • Eun-Seok Shin
    • 3
  1. 1.Division of Cardiology, Department of Internal MedicineKangwon National University School of MedicineChuncheonSouth Korea
  2. 2.Department of CardiologyKosin University School of MedicineBusanSouth Korea
  3. 3.Department of CardiologyUlsan University Hospital, University of Ulsan College of MedicineUlsanSouth Korea
  4. 4.Division of BiostatisticsResearch Institute of Convergence for Biomedical Science and Technology, Pusan National University YangSan HospitalYangsanSouth Korea
  5. 5.Department of CardiologyGyeongsang National University Hospital and Gyeongsang National University School of MedicineJinjuSouth Korea
  6. 6.Department of Internal Medicine and Cardiovascular CenterSeoul National University HospitalSeoulSouth Korea

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