Abstract 17330: Relation Between Coronary Plaque Characteristics in Culprit Lesions and C-Reactive Protein Elevation after Percutaneous Coronary Intervention in Patients with Effort Angina Pectoris
Background: A significant increase in plasma C-reactive protein(CRP) after percutaneous coronary intervention(PCI) has been reported to be a predictor of long term cardiovascular events in patients with stable angina pectoris. The aim of this study was to investigate the relation between the plasma CRP before and after PCI and the coronary plaque characteristics in patients with effort angina pectoris.
Methods: 54 patients with effort angina pectoris who underwent intravascular ultrasound(IVUS) and optical coherence tomography(OCT) before PCI were included. Patients were divided into a high increment in CRP one day after PCI(high-delta CRP) group(n=14, ≥3mg/l: 14.4±10.6mg/l) and a low-delta CRP group(n=40, <3mg/l: 0.84±1.1mg/l). Arterial remodeling of culprit lesion was assessed by IVUS. OCT plaque characteristics for lipid content, thrombus and fibrous cap thickness were examined using previously validated criteria. In addition, the presence of lipid-laden intima with characterized a high signal band with attenuation and a diffuse border was evaluated.
Results: Ruptured plaque was not observed. The thickness of the fibrous cap in the low-delta CRP group was significantly larger than that of high-delta CRP group(112.3±42.5μ m vs. 77.1±28.1μ m P<0.01). And, lipid-laden intima was more frequently observed in high-delta CRP group than in the low -delta CRP group(84% vs. 25%, respectively; P<0.05). Higher CRP values before PCI were observed in high-delta CRP group(2.9±2.9 mg/l vs. 1.1±1.4 mg/l, respectively; P<0.05). Remodeling index, calcified and lipid plaque frequency and lipid profile were comparable between two groups. An increment of Troponin-I level after PCI had a tendency to be higher in high-delta CRP group than low-delta CRP group(2.75±3.39 ng/ml vs. 0.97±2.57 ng/ml, respectively; p=0.067).
Conclusion: This result suggests that existence of thin fibrous cap with non-ruptured lipid plaque accelerates to inflammatory process in coronary atherosclerotic lesion by mechanical stress due to PCI and that OCT is useful for detecting the appearance of coronary plaque instability in patients with effort angina pectoris.
- © 2011 by American Heart Association, Inc.