Intravascular Ultrasound Characteristics And Its Correlation With Serum Inflammatory Indexes In Unstable Coronary Artery Diseases

Objective:This study retrospectively studied the plaque properties and plaque stability of NSTE-ACS and SAP.To investigate the correlation between serum inflammatory markers and plaque stability.Methods:Collected from January 2019 to January 2021 in the second affiliated hospital of kunming medical university clinical diagnosis of heart in the hospital with Non st-elevation acute coronary syndrome(Non-ST elevation acute coronary syndrome,NSTE-ACS)118 cases,patients with stable angina(stable angina pectoris,SAP),82 cases of patients,it can be divided into NSTE-ACS and SAP group,all patients were performed coronary angiography and IVUS examination.First,IVUS examination was used to identify the nature of the lesions,and the different pathological characteristics of NSTE-ACS and SAP patients were defined.Then,unstable plaque patients and stable plaque patients were differentiated in the NSTE-ACS group and the SAP group according to plaque stability.The first serum inflammatory indexes(NLR,hs-CRP,IL-6)of the enrolled patients were collected to investigate the correlation between different plaque properties and serum inflammatory indexes.Results:(1)Comparison of general conditions:there were no statistically significant differences in age,gender,BMI,blood pressure,HbAlc,uric acid,HDL-C,TG,TC,smoking,history of hypertension,history of diabetes,and history of hyperuricemia between the two groups(P>0.05).LDL-C in NSTE-ACS group was significantly higher than that in SAP group,and the difference was statistically significant(P<0.05).(2)In terms of plaque stability,the distribution of unstable plaques in NSTE-ACS group was significantly higher than that in SAP group(P<0.05).(3)In terms of the tissue properties of plaques,the majority of plaques in NSTE-ACS group were thin-cap fibroatheromas(TCFA).The majority of plaques in SAP group were fibrous plaques.The distribution of ruptured plaques in NSTE-ACS group was higher than that in SAP group(P<0.05).The distribution of non-thin fibrous cap lipids,calcified plaques and mixed plaques was similar between the two groups,and the difference was not statistically significant(P>0.05).(4)Quantitative indicators under IVUS:EEMA,PA,PB,EI and RI in NSTE-ACS group were higher than those in SAP group(P<0.05);There was no significant difference in MLA between the two groups(P>0.05).(5)Multi variate analysis of variance indicated that the plaque properties were closely related to NLR,hs-CRP and IL-6(P<0.05),and the values of NLR,hs-CRP and IL-6 in patients with unstable plaques were significantly higher than those in stable plaques(P<0.05).There was no significant correlation between NLR,hs-CRP and IL-6(P>0.05).(6)Pearson analysis showed that NLR,IL-6,hs-CRP had no correlation with MLA,PA,PB,RI,EI(P>0.05).(7)ROC curve showed that The area under The curve(AUC)of unstable plaques diagnosed by NLR was 0.784,95%confidence interval(CI)was 0.721-0.847(P<0.05),and The optimal cut-off value was 2.385,The sensitivity and specificity were 0.524 and 0.918 respectively,the AUC of IL-6 for the diagnosis of unstable plaques was 0.849,95%confidence interval(CI)was 0.791-0.901(P<0.01),and the optimal cut-off value was 23.925pg/ml,the sensitivity and specificity were 0.482 and 0.882 respectively,the AUC of hs-CRP for the diagnosis of unstable plaques was 0.815,95%confidence interval(CI)was 0.756-0.847(P<0.01),and the optimal cutoff was 4.53mg/L,the sensitivity and specificity were 0.416 and 0.919 respectively.(8)Bariate Logistic regression analysis of multivariate factors(sex,age,smoking,hypertension,diabetes,LDL-C,NLR,hs-CRP,IL-6)showed that LDL-C(OR=1.129,95%CI:0.745-2.893,P<0.05),NLR(OR=1.505,95%CI:1.152-2.179,P<0.05),IL-6(OR=1.318,95%CI:1.050-1.863,P<0.05)and hs-CRP(OR=1.385,95%CI:1.205-3.041,P<0.05)were risk factors for unstable plaques.Conclusion:(1)Unstable plaques are closely related to the occurrence of NSTE-ACS,in which thin fibrous cap plaques are more common than ruptured plaques,and the lesions have heavy plaque load,severe eccentrism,and positive lumen remodeling.There was no correlation between lumen area and the occurrence of NSTE-ACS.(2)NLR,hs-CRP and IL-6 were closely related to plaque properties,and NLR,hs-CRP and IL-6 were significantly higher in patients with unstable plaques than in patients with stable plaques.It is independent of the type of lesion.It was not related to plaque load,lumen area or plaque morphology.NLR,hs-CRP and IL-6 all have predictive value for unstable plaques.(3)LDL-C,NLR,IL-6 and hs-CRP are risk factors for the formation of unstable plaques.