Correlation of Remnant Cholesterol with Vulnerable Plaque Characteristics in Patients with Acute Coronary Syndrome

Abstract

Background Remnant cholesterol (RC) is considered an important indicator to assess the risk of atherosclerotic cardiovascular disease (ASCVD), and the adverse effects of vulnerable plaque on the clinical prognosis of ASCVD patients has been demonstrated, however, there are few studies on the correlation between RC and vulnerable plaque characteristics.Objective To investigate the correlation between RC and vulnerable plaque characteristics in patients with acute coronary syndrome (ACS) .Methods One hundred and forth-two ACS patients admitted to Hebei general hospital who underwent percutaneous coronary intervention (PCI) and optical coherence tomography (OCT) from January 2017 to October 2021 were selected as the study subjects. The baseline data of the patients were collected, the characteristics of intracoronary plaques were analyzed by OCT, and the patients were divided into the TCFA group (25 cases) and the non-TCFA group (117 cases) according to the presence or absence of thin-cap fibroatheroma (TCFA) in OCT results. Multivariate Logistic regression was used to analyze the influencing factors of intracoronary TCFA in ACS patients. The receiver operating characteristic (ROC) curve was plotted to assess the predictive value of RC on TCFA; Spearman rank correlation was used to analyze the correlation between RC and intracoronary plaques characteristics.Results The proportion of patients with diabetes history and RC level in the TCFA group were higher than those in the non-TCFA group (P<0.05). The results of multivariate Logistic regression analysis showed that high RC level〔OR=5.241, 95%CI (1.195, 22.995), P=0.028〕was a risk factor for TCFA in ACS patients. The area under the ROC curve (AUC) of RC to predict intracoronary TCFA in patients with ACS was 0.689〔95%CI (0.579, 0.798), P=0.003〕, with an optimal cut-off value of 0.475 mmol/L, sensitivity and specificity of 76.0% and 65.0%, respectively. The results of Spearman rank correlation analysis showed that RC was positively correlated with plaque rupture, TCFA, and macrophage infiltration (rs=0.213, 0.249, 0.186; P<0.05) .Conclusion Elevated RC level may be a risk factor for TCFA, which has a certain predictive value for plaque vulnerability in ACS patients and is associated with the progression of intracoronary inflammation.

Keywords

• coronary disease|cholesterol|acute coronary syndrome|remnant cholesterol|plaque, atherosclerotic|optical coherence tomography