IVUS Image Of The Coronary Artery Plaque And The Correlation Analysis Of The Coronary Artery Plaque With PAPP-aLevel

Objective：To investigate the coronary lesion characteristics and the nature of plaque andcoronary vascular remodeling in different age group of coronary heart patients, Toinvestigate the relationship between PAPP-A levels and early plaque stability.Method：1）30patients that were enrolled were divided byage <65years and≥65years.Vascular lesions, lesion count and lesion length were analyzed resnectively in two groupsaccording to CAG image. And minimal external elastic membrane area、minimal lumenarea、plaque area、 plaque burden、lipid pool area、lipid pool/plaque area、 fibrous capthickness、 remodeling index、 positive remodeling、 negative remodeling、 plaquecharacteristic were compared between two groups according to IVUS image；2）12patients with IVUS-guided coronary stent and108patients without IVUS-guided coronarystent were enrolled, with an3to24months follow up. The incidence of MACE wascompared in these two groups；3）161patients under went PCI enrolled were divideddivided into two groups by in-stent restenosis.Retrospective analysis was performed andrisk factors;93patients were divided into four groups according to different types ofcoronary heart disease. PAPP-A level in different coronary artery disease mearsured thecorrelation with Gensini score was investigated.Result：1. The difference in LM、 LAD、 LCX、 RCA、 the double vessel disease、the tubular lesions and limitations lesion between2groups was not statistically significant.While the difference in single-vessel disease，multivessel disease and diffuse lesions wasstatistically significant between the two groups （P values were:0.035、0.042、0.046)；The single-vessel disease is more common in patients <65years, multivessel disease anddiffuse lesions are more common in patients aged≥65；2. Minimal external elasticmembrane area、lipid pool area、 lipid pool/plaque area and remodeling index were muchhigher in patients <65years,(P values were:0.048、0.042、0.002、0.001)；The plaqueburden was significantly higher in patients aged <65,(P=0.016)； Fibrous cap thickness was thinner in patients aged≥65years, the difference was statisticallysignificant (P=0.000)； Minimum lumen area, plaque area were not significantlydifferent between two groups；3.The differences between soft plaques、positive remodeling、negative remodeling in two groups were statistically significant (P values were0.037、0.035、0.024)； patients age <65years were mainly with positive remodeling andpatients≥65years mainly with negative remodeling；patients≥65years calcified plaqueblock is significantly more than patients age <65years,(P=0.033)；Between the twogroups, fibrous plaque、 mixed plaque、plaque eccentricity、concentricity plaque were notsignificant difference；4. Compared with non-IVUS guided group, IVUS guided grouppatients had a lower incidence of in-stent restenosis, recurrent angina, recurrent myocardialinfarction, reoperation of PCI and lower incidence of death, however these differenceswere not statistically significant.5.The follow-up result of CAG in two groupsdemonstrated thatdiabetes、smoking、high cholesterol level、high blood pressure、medication adherence、bifurcation lesion、vessel diameter＜2.75mm were significantlydifferent between two groups (the P value were0.000、0.000、0.003、0.000、0.002、0.046、0.036)6. Compared with control group, PAPP-A concentration in patients with coronaryheart disease were different，AMI group and UAP group were significantly higher（P＜0.05)，SAP group and the normal group were not statistically significant different,difference between UAP group and SAP group was statistically significant, butthe difference between the AMI group and UAP group was not statistically significant；7.PAPP-A levels and Gensini score were not correlated (P=0.522).Conclusion：1. The patients <65years with coronary artery disease mainly present withpositive remodelling, less plaque burden、large lipid pool area、thin fibrous cap、and softplaque；The patients≥65years mainly had negative remodeling, heavy plaque burden、small lipid pool area、fibrous cap thick、hard plaque.2. IVUS-guided group patients haslarge MLA、better stent malapposition and better stent expansion、less incident of in-stentrestenosis3.The incident of in-stent restenosis is associated with glycemia、blood pressure、medicine compliance、smoking、bifurcation lesionand small vessel.4. PAPP-A can be usedas an early bio-marker to evaluate whether the plaque is stable in different coronary artery disease patients.