Elevated Lipoprotein-Associated Phospholipase A2 Is Associated with Progression of Nonculprit Lesions after Percutaneous Coronary Intervention

Abstract

Lipoprotein-associated phospholipase A2 (Lp-PLA 2 ) is an enzyme that hydrolyzes oxidized phospholipids to generate bioactive proatherogenic products. Nonculprit lesions have been assumed to contribute to the pathogenesis of recurrent acute coronary syndrome (ACS). The role of LP-PLA 2 in the progression of nonculprit coronary lesions after successful percutaneous coronary intervention (PCI) remains unclear. Our study included 123 patients with ACS who underwent initial PCI and a long-term follow-up (mean interval, one year) with coronary angiography. Among them, 19 patients were diagnosed as the progression of nonculprit lesions, based on the presence of at least one of the following factors: (1) ≥ 10% reduction in the diameter of a preexisting ≥ 50% stenosis; (2) ≥ 30% reduction in the diameter of a < 50% stenosis; and (3) early-onset stenosis with ≥ 30% reduction in the diameter of a segment that was normal on the primary angiogram. Blood sampling was drawn from all patients at 12-14 hours after PCI. The ACS patients with progression had higher total cholesterol (4.47 ± 1.02 mmol/L vs. 3.59 ± 0.57 mmol/L, P < 0.05), higher levels of Lp-PLA 2 activity (14.39 ± 6.13 nmol/min/ml vs. 8.86 ± 3.14 nmol/min/ml, P < 0.001) and a higher proportion of multi-vessel disease than those without progression. Multivariate logistic regression analysis showed that Lp-PLA 2 activity (β = 0.024, P = 0.005) was an independent predictor for rapid progression of nonculprit coronary lesions. In conclusion, elevated Lp-PLA2 activity is associated with rapid progression of nonculprit coronary lesions in ACS patients who underwent PCI.

Rapid Progression of Coronary Atherosclerosis: A Review

“…There is no universal definition of rapid progression of atherosclerosis. However, most of the studies describing this phenomenon have used the following definition: (i) > or = 10% diameter reduction of at least one preexisting stenosis > or = 50%, (ii) > or = 30% diameter reduction of a preexisting stenosis <50%, and (iii) progression of a lesion to total occlusion over a few months [ 17 – 21 , 23 ].…”

“…A study of 123 patients with ACS who underwent PCI and follow up (mean interval of 1 year) angiography showed Lp-PLA2 to be an independent predictor of rapid progression of nonculprit coronary lesions. Rapid progression was defined as (i) > or = 10% diameter reduction of at least one preexisting stenosis > or = 50%, (ii) > or = 30% diameter reduction of a preexisting stenosis <50%, and (iii) progression of a lesion to total occlusion [ 23 ]. Measurement of the marker was done only one time (12–14 hours after PCI).…”

The natural course of nonculprit coronary artery lesions; analysis by serial quantitative coronary angiography

“…In the clinic, we can occasionally meet coronary artery disease patients with initially insignificant nonculprit lesions, which rapidly progress to cause ischemia despite standard medical treatment. These patients show a higher incidence of heart failure, recurrent acute coronary syndrome, leading to deterioration of the patients’ quality of life [ 3 ]. Recent studies have described a few mechanisms to explain the rapid progression in coronary stenosis, including coronary vasospasm [ 4 ], a complex stenosis morphology [ 5 ], and the systemic inflammatory status [ 6 ].…”