| Objective:(1) We compared plasma levels of Lipoprotein-associated phospholipase A2(Lp-PLA2) within 24 hours of an acute coronary syndrome(ACS)and a month after(27.4±4.3d),and evaluated its predictive value on the short-term outcomes in patients with ACS.(2) To study the relationship between Lp-PLA2 and ankle brachial index(ABI), and then to explore the effects of ABI on coronary heart disease.Methods:(1)Patients who experienced an ACS meeting standardized criteria from December 2014 to November 2015(n=174) were identified and followed up for average 9 months(5 to 14 months), The following major adverse cardiovascular events(MACE) were recorded: cardiac death, remyocardial infarction, recurrent unstable angina, acute heart failure, target vessel revascularization or stoke. Compare the changes of plasma Lp-PLA2 levels in two times, and analyzed their predictive value on MACE.(2)247 patients who were suspected for coronary heart disease and underwent coronary angiography were enrolled. Patients having at least one stenosis( left main coronary artery or left anterior descending coronary artery, the left circumflex artery, right coronary artery and its branches) greater than or equal to 50%, were defined as a group of CHD(n=187), and normal or less than 50% were identified as the control group. According to the clinical manifestations and changes of ECG, clinical laboratory, the CHD group were then divided into ACS group of 126 cases and 61 with stable angina pectoris. All patients were detected with ankle brachial index(ABI), and then we analyzed its influence on CHD and its correlation with Lp-PLA2.Results:(1)Plasma Lp-PLA2 levels were significantly lower in ACS acute subjects than in ACS recovery subjects(157.86±96.27 vs 203.35±113.52 ng/m L, P<0.01);(2)61 cases(35.1) of MACE had occurred during the follow-up, of them, 2(1.2%) had cardiac death, 7(4.0%) had stroke,7(4.0%) remyocardial infarction,36(20.7%) UA, 5(2.9%) acute heart failure and 4(2.3%) had revascularization;(3)The mean Lp-PLA2 level was higher in patients with MACE than the others(206.63±132.69 vs 131.53±53.73 ng/ml,P<0.01); while the mean baseline Lp-PLA2 level was similar in two groups(225.67±119.82 vs 191.31±108.61ng/ml,P=0.056); 46 patients had a higher Lp-PLA2 level at 30 days than that measured at baseline, and of those, 25 cases(54.3%) of MACE occurred; otherwise, the Lp-PLA2 levels decreased at 30 days among the rest 128 patients, and 36(28.1%) of them had experienced a MACE;(4)The area under the ROC curve(AUC)for Lp-PLA2 at baseline and 30 days after were 0.587(SE=0.046,P=0.06) and 0.758(SE=0.035,P<0.01) respectively when to assess the adverse outcomes after ACS;Kaplan-Meire event rates by tertiles of Lp-PLA2 at baseline for MACE were similar among each groups, P>0.05; the rates by tertiles of Lp-PLA2 after 30 days of follow-up for MACE were different among each groups, and the highest group was the worst, P<0.05;the Kaplan-Meire event rates by the change of Lp-PLA2 for MACE was higher in patients who had an increased Lp-PLA2 level at 30 days, P<0.05;(5)Cox regression analysis found that hypertension、baseline fibrinogen、LVEF、recovery Lp-PLA2 level、an increased Lp-PLA2 level at 30 days were independently associated with the short-term adverse outcomes;(6)ABI differed from each group significantly, and in patients with ACS was the lowest(1.09±0.09 vs 1.03±0.11 vs 0.99±0.12, P<0.05);in multivessel disease groups ABI decreased significantly and people with tri-vessel disease had the lowest, P<0.05; As for Lp-PLA2, the control group was much lower than the other groups, P<0.05, but it was not correlated with coronary lession complexity;(7)There was a strong correlation between Lp-PLA2 and ABI in each group, but in ACS, the correlation coefficient was a little bit weaker;(8)The AUC for ABI and Lp-PLA2 was 0.735(SE=0.037,P<0.01), 0.678(SE=0.033,P<0.01) respectively when to diagnose CHD; and the AUC for the combination of them both was higher(0. 749(SE=0.038,P<0.01).Conclusion:(1) Lp-PLA2 is not useful for risk stratification when measured early after ACS. At 30 days after, Lp-PLA2 is associated with an increased risk of adverse cardiovascular events;(2)For most of the ACS patients, the plasma Lp-PLA2 levels decrease during the 30 days follow-up, and they experience a relatively lower risk of MACEs; An elevated Lp-PLA2 level than the baseline is an independent prognostic factor for the adverse short-term outcomes in ACS patients.(3)Lp-PLA2 is inversely correlated with LDL-C, but not with gender、age、 hypertension、diabetes mellitus or smoke.(4)An abnormal ABI and Lp-PLA2 are both independent risk factors for CHD, but it’s ABI other than Lp-PLA2 that is significantly associated with the degree of vessle lessions;(5)ABI is significantly correlated with Lp-PLA2, and when combined together the diagnostic value for CHD can be improved. |
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