Key result
The combination of serum markers MMP-9, LOX-1, and YKL-40 identified asymptomatic carotid vulnerable plaques with an AUC of 0.850 and 84.92% diagnostic accuracy, significantly outperforming the Crouse Plaque Score.
Why the study?
To explore factors influencing carotid atherosclerotic plaque formation and stability to enable early identification of vulnerable plaques and high-risk patients for early intervention.
Does the combination of serum markers (MMP-9, LOX-1, YKL-40) and carotid ultrasound improve the early identification of vulnerable plaques in asymptomatic patients?
Cross-Sectional (n=302)
No
Does the combination of serum markers (MMP-9, LOX-1, YKL-40) and carotid ultrasound improve the early identification of vulnerable plaques in asymptomatic patients?
Effect estimate: AUC 0.850 (95% CI 0.795-0.905)
Absolute Event Rate: 84.92% vs 61.9%
p-value: p=0.000
A combination of serum biomarkers (MMP-9, LOX-1, YKL-40) and carotid ultrasound provides high diagnostic accuracy for the early identification of vulnerable carotid plaques in asymptomatic patients.
May support noninvasive detection of asymptomatic vulnerable plaques; hypothesis-generating and requires prospective validation before clinical adoption.
Background This study was to explore the influencing factors of atherosclerotic plaque formation and stability in patients with asymptomatic carotid atherosclerotic plaques, so as to identify the vulnerable plaques at early stage, and then find high-risk group of cardio-cerebrovascular events for early clinical intervention to reduce related mortality and disability. Methods A total of 302 enrolled patients with asymptomatic carotid atherosclerotic plaques were divided into 3 groups based on the results of carotid artery color Doppler ultrasound: atherosclerotic unstable plaque (UP) group, atherosclerotic stable plaque (SP) group, and control group without plaques. Serum markers were measured by ELISA. χ 2 test, t test, Pearson correlation analysis, and Logistic multivariate regression analysis were used in the analysis, and P < 0.05 was considered statistically significant. Results It revealed that high MMP-9, LOX-1and YKL-40 were independent risk factors for unstable plaque formation. The area under the curve (AUC) of serum markers combined with MMP-9, LOX-1 and YKL-40 was 0.850, with sensitivity 87.67%, specificity 81.13%, and diagnostic accuracy 84.92%, which was significantly better than the individual diagnostic efficacy of other three factors. The accuracy rate of Crouse Plaque Score (CPS) in the diagnosis of vulnerable plaques was 61.90%, the 10-year ICVD diagnosis accuracy rate was 56.75%, and the diagnostic accuracy of serum markers was significantly better than CPS and 10-year ICVD. Conclusion Noninvasive cervical color Doppler ultrasound combined with serum markers MMP-9, LOX-1 and YKL-40 have significant early recognition effect on asymptomatic carotid vulnerable plaque patients.
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Jiao et al. (2020) conducted a cross-sectional in Asymptomatic carotid atherosclerotic plaques (n=302). Combined serum markers (MMP-9, LOX-1, YKL-40) vs. Crouse Plaque Score (CPS) and 10-year ICVD risk was evaluated on Diagnosis of vulnerable plaques (Area Under the Curve) (AUC 0.850, 95% CI 0.795-0.905, p=0.000). The combination of serum markers MMP-9, LOX-1, and YKL-40 identified asymptomatic carotid vulnerable plaques with an AUC of 0.850 and 84.92% diagnostic accuracy, significantly outperforming the Crouse Plaque Score.
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