Author + information
- Mami Watanabe1,
- Raisuke Iijima1,
- Norihiro Kogame2,
- Fumiyuki Hayashi3,
- Masahide Tokue3,
- Tsuyoshi Ono3,
- Hidehiko Hara1 and
- Masato Nakamura1
Proprotein convertase subtilisin/kexin 9 (PCSK9) becomes a novel target to treatment of hypercholesterolemia. This study aimed to investigate the association between serum PCSK9 levels and the coronary atherosclerotic plaque in patients with ACS, as assessed by integrated backscatter intravascular ultrasound (IB-IVUS).
We enrolled 30 patients from Explore-J with ACS who underwent successful primary percutaneous coronary intervention (PCI). The serum PCSK9 levels were determined by ELISA from blood samples drawn within 1week after admission. The cross-sectional vessel area and plaque area were measured in the culprit lesions and proximal segment in target vessels by serial IVUS. Spotty calcification was defined as a lesion containing small calcium deposits within an arc of less than 90°for all calcium deposits.
Median matured PCSK9 level was 334.5 ng/ml (Ranged from 195 to 577 ng/ml). Based on this cut-off points, patients were divided into 2 groups; the higher PSCK9 levels and the lower PCSK9 levels. In patient characteristics and baseline labo data and baseline medication and procedure characteristics, there was no significant difference except Lp(a) levels. In culprit lesions, calcification plaque area was significantly larger in the higher group, whereas there was no significant difference in plaque area and all tissue fraction. Spotty calcification was frequently detected in the higher group. In proximal segment in target vessels, plaque burden, fibrous plaque area was significantly larger in the higher group, but there was no difference in other plaque fraction.
|All (n=30)||Lower group (n=15)||Higher group (n=15)||p|
|Vessel area (mm2), mean±SD||12.09±2.75||11.87±2.92||12.31±2.65||0.67|
|Lumen area (mm2), mean±SD||3.64±0.74||3.44±0.74||3.85±0.71||0.13|
|Plaque area (mm2), mean±SD||8.44±2.54||8.42±2.71||8.45±2.44||0.97|
|Plaque burden (%), mean±SD||66.7±13.37||65.70±17.76||67.70±7.24||0.69|
|Lesion length (mm), mean±SD||21.51±9.81||20.76±8.41||22.25±11.28||0.68|
|Stent length (mm), mean±SD||22.6±10.26||21.6±8.85||23.6±11.73||0.60|
|Spotty Calcification (%), n (%)||15 (50%)||4 (26.7%)||11(73.3%)||<0.05|
In ACS patients, calcification plaque area in culprit lesion was larger in higher PCSK9 group. Because the presence of spotty calcification in culprit lesion is implicated in plaque vulnerability, PCSK9 levels may be associated with underlined mechanism of ACS.
IMAGING: Imaging: Intravascular