Relation of high sensitivity c-reactive protein and low-density lipoprotein-cholesterol level to coronary artery plaque morphology and plaque rupture in patients with acute coronary syndromes

Abstract Background Atherosclerosis is a lipid driven inflammatory process leading to plaque formation and plaque progression. Inflammation plays specifically a key role in the development of acute coronary syndromes (ACS). However, the relation of high sensitivity C-reactive protein (hs-CRP), plaque morphology and plaque rupture in patients with ACS has not been fully investigated. Purpose This study aimed to evaluate the relation of hs-CRP and low-density lipoprotein (LDL)-cholesterol levels to the prevalence of plaque morphology and plaque rupture in patients with ACS. Methods A total of 417 patients who underwent pre-intervention optical coherence tomography (OCT) imaging were analyzed. Patients were stratified based on hs-CRP levels (≤2 mg/L or 2 mg/L) and LDL-cholesterol levels (≤120 mg/dL or 120 mg/dL). The underlying pathology, the prevalence of thin-cap fibroatheroma (TCFA) and lipid burden at the culprit lesion were compared between these groups. Results The relative prevalence of plaque rupture was higher in patients with high LDL-cholesterol levels (79.6% vs. 85.7%, p = 0.01) and they had a higher prevalence of TCFA (63.2% vs.76%, p = 0.006). Patients with high LDL-cholesterol levels also showed a higher lipid plaque burden (2241 (1346-3326) vs. 2640 (1686 -3854), p = 0.01). No differences in the prevalence of plaque rupture, TCFA or lipid burden were observed between patients with high and low hs-CRP levels regardless of their LDL-cholesterol levels, whereas the presence of macrophages at the culprit lesion was significantly higher in patients in the high hs-CRP levels (84.0% vs. 91.0%, p=0.02). Conclusions High LDL-cholesterol levels were associated with a higher prevalence of lipid burden, TCFA and plaque rupture in patients with ACS, while there were no differences in plaque morphology in patients with low hs-CRP levels compared to those with high hs-CRP levels.