Key result
Combined MMP-9, LOX-1, and YKL-40 identifies vulnerable carotid plaques with an AUC of ~0.85.
Why the study?
Early identification of vulnerable carotid plaques in asymptomatic patients is needed to find high-risk groups for cardio-cerebrovascular events and enable early intervention.
Do serum markers (MMP-9, LOX-1, YKL-40) improve the early identification of vulnerable carotid plaques in asymptomatic patients compared to plaque scores and 10-year ICVD?
Cross-Sectional (n=302)
No
Do serum markers (MMP-9, LOX-1, YKL-40) improve the early identification of vulnerable carotid plaques in asymptomatic patients compared to plaque scores and 10-year ICVD?
Effect estimate: AUC 0.850 (95% CI 0.795-0.905)
p-value: p=<0.001
A combination of serum markers (MMP-9, LOX-1, YKL-40) provides higher diagnostic accuracy for identifying vulnerable carotid plaques in asymptomatic patients than traditional plaque scores or 10-year ICVD risk.
Serum marker panel may aid vulnerable plaque detection in asymptomatic patients; leaves open clinical adoption pending prospective validation.
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. χ2 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 diabetes, 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 Serum markers predict potential atherosclerotic cardiovascular and cerebrovascular disease (ASCCVD) patients better than plaque scores and 10-year ICVD. This study provides a new idea for the early identification of high-risk population of cardiovascular and cerebrovascular events by combining 10-year ICVD and serum markers.
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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. Carotid plaque score (CPS) and 10-year ICVD risk was evaluated on Diagnostic accuracy (AUC) for identifying vulnerable plaques (AUC 0.850, 95% CI 0.795-0.905, p=<0.001). The combination of serum markers MMP-9, LOX-1, and YKL-40 identified vulnerable carotid plaques with an AUC of 0.850, significantly outperforming individual markers, carotid plaque score, and 10-year ICVD risk.
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