In STEMI patients, plaque rupture with high plasma PTX3 was associated with a higher risk of MACE compared to plaque erosion with low PTX3 (24.1% vs 5.3%; HR 5.63, 95% CI 1.57-20.16, P=0.008).
Cohort (n=236)
Do culprit-plaque morphology and plasma PTX3 levels predict major adverse cardiovascular events in patients with STEMI?
Combining culprit-plaque morphology assessed by OCT with plasma PTX3 levels enhances the prediction of major adverse cardiovascular events in patients with STEMI.
Hazard Ratio: 5.63 (95% CI 1.57–20.16)
Absolute Event Rate: 24.1% vs 5.3%
p-value: p=0.008
BACKGROUND: Culprit‑plaque morphology plaque rupture (PR) and plaque erosion (PE) identified by optical coherence tomography (OCT) and biomarker of vascular inflammation, pentraxin-3 (PTX3), have been reported to influence clinical outcomes in coronary diseases. We aimed to investigate the prognostic implication of culprit-plaque morphology and plasma PTX3 for major adverse cardiovascular events (MACE) in patients with ST-segment elevation myocardial infarction (STEMI). METHODS: A total of 236 patients were enrolled and divided into four groups: PE/low-PTX3 (n = 57), PE/high-PTX3 (n = 47), PR/low-PTX3 (n = 78) and PR/high-PTX3 (n = 54). MACE was defined as the composite of all-cause death, recurrence of myocardial infarction, stroke and unplanned revascularization of any coronary artery. RESULTS: During the follow-up of 1.9 years, a total of 40 (16.9%) MACE were observed: 5.3% (3 patients) among patients with PE/low-PTX3, 21.3% (10 patients) among patients with PE/high-PTX3, 17.9% (14 patients) among patients with PR/low-PTX3 and 24.1% (13 patients) among patients with PR/high-PTX3 (Log rank P = 0.013). In fully adjusted analyses, patients with high-PTX3 were associated with higher MACE risk (HR: 2.40, 95% CI: 1.26-4.57, P = 0.008). Patients with PR/high-PTX3 (HR: 5.63, 95% CI: 1.57-20.16, P = 0.008) and PE/high-PTX3 (HR: 5.44, 95% CI: 1.46-20.29, P = 0.012) presented higher MACE risk than those with PE/low-PTX3. Adding plasma PTX3 levels and PR to the risk prediction model increased the area under curves to 76.1% (95% CI: 67.6-84.5%) and the NRI (28.1%, 95% CI: 0.3-48.3%, P=0.040) and IDI (2.4%, 95% CI: 0.1-12.9%, P = 0.040). CONCLUSION: Patients with PR/high-PTX3 and PE/high-PTX3 presented a poorer prognosis than those with PE/low-PTX3. Combining the culprit-plaque morphology with PTX3 enhanced the predictive ability for MACE and contributed to better identification of high-risk patients. TRIAL REGISTRATION NUMBER: This study is registered at clinical trials.gov as NCT03593928.
Wang et al. (Wed,) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=236). Plaque rupture with high plasma PTX3 vs. Plaque erosion with low plasma PTX3 was evaluated on Major adverse cardiovascular events (MACE), defined as the composite of all-cause death, recurrence of myocardial infarction, stroke and unplanned revascularization of any coronary artery (HR 5.63, 95% CI 1.57-20.16, p=0.008). In STEMI patients, plaque rupture with high plasma PTX3 was associated with a higher risk of MACE compared to plaque erosion with low PTX3 (24.1% vs 5.3%; HR 5.63, 95% CI 1.57-20.16, P=0.008).