The combined presence of an elevated atherogenic index of plasma and thin-cap fibroatheroma provided significant risk stratification for major adverse cardiovascular events in STEMI patients (log-rank p=0.027), with an adjusted HR of 4.98 (95% CI 0.62-39.89, p=0.131) for the highest risk group.
Cohort (n=274)
No
Does the combination of high atherogenic index of plasma and thin-cap fibroatheroma predict major adverse cardiovascular events in STEMI patients undergoing primary PCI?
The combination of the atherogenic index of plasma and OCT-identified thin-cap fibroatheroma provides synergistic prognostic value for predicting major adverse cardiovascular events in STEMI patients.
Hazard Ratio: 4.98 (95% CI 0.62–39.89)
Absolute Event Rate: 7% vs 11.1%
p-value: p=0.131
BACKGROUND AND AIM: This prospective study investigated plaque morphologies based on the underlying culprit lesion pathology in relation to the Atherogenic Index of Plasma (AIP) in patients with acute ST-elevated myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention and optical coherence tomography (OCT) for assessment of culprit lesions. The aim of the study was to elucidate the effects of the AIP index and plaque type on the incidence of major adverse cardiovascular events (MACEs). METHODS: A total of 274 patients with STEMI aged ≥ 18 years who underwent pre-intervention OCT imaging of culprit lesions between March 2017 and March 2019 were enrolled. AIP index was calculated using the formula: log 10 (triglycerides TG/ high-density lipoprotein cholesterol HDL-C). We stratified the cohort into four groups according to the presence of Thin-Cap Fibroatheroma (TCFA), as assessed by OCT, and the cutoff value of AIP: Group I consisted of patients with AIP cutoff and Group IV comprised patients with AIP > cutoff & with TCFA. OUTCOMES: Patients in Group IV exhibited a higher prevalence of Diabetes Mellitus (p = 0.012), elevated triglyceride-glucose index (TyG) levels (p cutoff & with TCFA) increased by compared to those in Group I. Kaplan-Meier analyses confirmed risk stratification for MACEs based on interactions between AIP-TCFA interaction (log-rank p = 0.027), AIP-plaque interaction (log-rank p = 0.033), AIP-mixed plaque interaction (log-rank p = 0.041), AIP-lipid plaque interaction (log-rank p < 0.001), AIP- macrophage interaction (log-rank p = 0.032). CONCLUSION: Microstructural features observed via OCT for culprit lesions, combined with the AIP index-an important marker for cardiovascular disease-may be utilized clinically to support risk stratification and predict adverse events among STEMI patients.
Zhao et al. (Wed,) conducted a cohort in ST-elevated myocardial infarction (STEMI) (n=274). Elevated Atherogenic Index of Plasma (AIP) and Thin-Cap Fibroatheroma (TCFA) vs. Low AIP without TCFA was evaluated on Major adverse cardiovascular events (MACEs) (HR 4.98, 95% CI 0.62-39.89, p=0.131). The combined presence of an elevated atherogenic index of plasma and thin-cap fibroatheroma provided significant risk stratification for major adverse cardiovascular events in STEMI patients (log-rank p=0.027), with an adjusted HR of 4.98 (95% CI 0.62-39.89, p=0.131) for the highest risk group.