Plasma Lipoprotein-Associated Phospholipase A2 Level Is an Independent Predictor of High Thrombus Burden in Patients With Acute ST-segment Elevation Myocardial Infarction

Abstract

SummaryLipoprotein-associated phospholipase A2 (Lp-PLA2) is an independent risk factor for plaque rupture and atherothrombotic events. However, the associations between serum Lp-PLA2 level and thrombus burden in ST-segment elevation myocardial infarction (STEMI) patients remain unknown.We consecutively enrolled 351 STEMI patients who underwent primary percutaneous coronary intervention (pPCI). Patients were assigned to a high thrombus burden (HTB) group (n = 230) and a low thrombus burden (LTB) group (n = 121). Baseline data were recorded during hospital admission. Plasma Lp-PLA2 concentration, coronary angiography results, and in-hospital mortality were measured. Plasma Lp-PLA2 level had a high correlation with thrombus burden score (TBS) before pPCI and it was found to be a significant independent predictor of HTB in STEMI patients (P < 0.05). Moreover, TBS, corrected thrombolysis in myocardial infarction (TIMI) frame count (cTFC), and plasma Lp-PLA2 level after pPCI in patients with HTB were significantly higher than those in patients with LTB (P < 0.05). Meanwhile, TIMI flow grade (TFG) and TIMI myocardial perfusion grade (TMPG) of HTB patients were markedly lower than those of LTB patients (P < 0.05). Additionally, correlations of plasma Lp-PLA2 level before pPCI with TFG before pPCI and TBS, cTFC, and TMPG after pPCI were modest (P < 0.05). However, the associations of plasma Lp-PLA2 level after pPCI with TFG, TBS, cTFC and TMPG were low (P < 0.05).These results demonstrated that the plasma Lp-PLA2 level before pPCI is an independent predictor of HTB in STEMI patients, resulting in modestly predicting blood flow and myocardial perfusion of the culprit artery. (Int Heart J 2016; 57: 689-696) Key words: Acute myocardial infarction S T-segment elevation myocardial infarction (STEMI) is the most serious type of coronary heart disease and has a high mortality. Accumulated data have indicated that coronary thrombosis in an infarct related artery (IRA) plays a significant role in the development of STEMI. Furthermore, high thrombus burden (HTB) in an IRA can lead to various conditions such as stent thrombosis, distal embolism, slowand non-reflow, and long-term mortality.1-3) Therefore, it is very important to find a good predictive factor of HTB so at an early point in time we can give these patients with HTB some more intensive medical therapy such as enhanced antiplatelet and anticoagulation therapy, despite the recent pharmacological and invasive developments (ie, glycoprotein IIb/IIIa antagonists and thrombectomy) used in primary percutaneous coronary intervention (pPCI) therapy. 3,4)The pathophysiology of STEMI involves inflammatory reaction, endothelium dysfunction, plaque rupture, platelet aggregation, and coagulation system activation. Inflammation plays an important role in the pathogenesis of plaque instability, and results in plaque rupture or erosion.5) Pathological and immunohistochemical staining in the ruptured plaques of patients who have died of AMI have shown a preponderance of inflammatory cell...

Predictive Value of Mean Platelet Volume/Platelet Count for Prognosis in Acute Myocardial Infarction

“…The culprit artery was determined with ECG, echocardiography, and angiographic findings by each operator. Exclusion criteria included (1) treatment with a fibrinolytic agent within the previous 24 hours, (2) hematoproliferative disorders, (3) culprit PCI failed, (4) autoimmune diseases or steroid therapy, (5) active infection, (6) end-stage liver or renal failure, and (7) no complete blood count available. The final study cohort consisted of 962 patients.…”

“…1) Inflammatory and thrombosis play important roles in the adverse prognosis of patients with STEMI. 2,3) Inappropriate platelet activation is a key element of the coronary thrombosis in patients with STEMI. 4) Moreover, it plays a critical role in stent thrombosis of patients with partially endothelialized intracoronary stents following PCI.…”

Lipoprotein-Associated Phospholipase A2 Activity Level may be complementary to Cardiactroponin I as a Biomarker for Acute Myocardial Infarction in Chinese Patients with Chest Pain

“…Lipoprotein-associated phospholipase A2 (Lp-PLA2) is associated with increased cardiovascular diseases risk, which relatively unique in its high specificity for vascular inflammation (Chung et al 2014, Maiolino et al 2015, Wei et al 2017). Lp-PLA2, produced by macrophages and lymphocytes, binds to low density lipoprotein, which can hydrolyze oxidized phospholipids on low density lipoprotein, and produce free fatty acids and lyolecithin (Wu et al 2016). Lp-PLA2 promotes the occurrence and development of inflammation and atherosclerosis.…”

Both baseline Selvester QRS score and change in QRS score predict prognosis in patients with acute ST-segment elevation myocardial infarction after percutaneous coronary intervention

“…Although the treatments for primary percutaneous coronary intervention (PCI) and other reperfusion therapies are widely performed, acute ST-segment elevation myocardial infarction (STEMI) remains a devastating disease that is associated with significantly increased morbidity and mortality [ 1 – 3 ]. Clinical trials have identified multiple prognostic predictors in patients with acute STEMI who have undergone PCI; these include cardiac troponin T, hemoglobin A1C, lipoprotein-associated phospholipase A2, and so on [ 4 – 8 ]. The Selvester QRS score contains 31 total possible points, with each point reflecting myocardial infarction involving 3% of the left ventricle; multiple versions of this test have been developed for widespread use in past decades [ 9 , 10 ].…”