AIM To investigate the predictive value of lipoprotein-associated phospholipase A2(Lp-PLA2) and pentraxin 3(PTX3) for in-stent restenosis (ISR) after percutaneous coronary intervention (PCI) in patients with coronary atherosclerotic heart disease (CHD).
METHODS A total of 379 CHD patients undergoing PCI for severe coronary artery stenosis were selected. According to the reexamination of ISR 6 months after the operation, 53 cases were divided into ISR group and 326 cases were non-ISR group. General clinical data of patients in both groups were collected. Lp-PLA2 and PTX3 levels in both groups were monitored 1d after surgery. Logistic stepwise regression was used to analyze the risk factors of ISR.The cross-sectional area of the elastic membrane (EEM-CSA), plaque area (PLA), minimum lumen area (MLA), intima proliferation area (IPA) and Gensini score were reviewed 6 months after the operation. The correlation of Lp-PLA2 and PTX3 with Gensini score, EEM-CSA, MLA, PLA, IPA was analyzed. The optimum cut-off value and AUC of Lp-PLA2 and PTX3 for predicting ISR were evaluated by ROC curve.
RESULTS (1) STEMI (P<0.05), smoking history (P<0.01), diabetes (P<0.01), LDL-C (P<0.05), stent tandem (P<0.05), bifurcation operation (P<0.01), stent placement duration (P<0.01), LP-PLA2 (P<0.05) and PTX3 (P<0.01) were higher in ISR group than in non-ISR group, HDL-C, LVEF and medication compliance were lower in ISR group than in non-ISR group (ALL P<0.05). Smoking (P<0.01), LDL-C (P<0.01), bifurcation procedure (P<0.01), diabetes (P<0.01), medication compliance (P<0.01), LP-PLA2 (P<0.05) and PTX3 (P<0.05) were independent risk factors for ISR. (2) The Gensini score of ISR group was higher than that of non-ISR group (P<0.01). Compared with the non-ISR group, the ISR group had larger IPA, PLA (all P<0.05) and smaller EM-CSA and MLA (all P<0.01). Lp-PLA2 and PTX3 were positively correlated with Gensini score, IPA and PLA (all P<0.01), but negatively correlated with EEM-CSA (all P<0.05) and MLA (all P<0.01). (3) The optimal truncation values of Lp-PLA2 and PTX3 for predicting ISR were 310.65 ng/ mL and 3.87 ng/ mL, respectively, and AUC were 0.780 (95%CI: 0.739-0.861) and 0.751 (95%CI: 0.751), respectively.The AUC of ISR predicted by LP-PLA2 combined with PTX3 was 0.832 (95%CI: 0.817-0.933), which was significantly higher than that predicted by LP-PLA2 and PTX3 alone (Z=3.083, P=0.021; Z=3.697, P=0.017).
CONCLUSION ISR patients have higher lP-PLA2 and PTX3 levels after PCI, and monitoring of lP-PLA2 and PTX3 levels after PCI is helpful to predict the risk of ISR occurrence, the combined detection enhances the predictive value of ISR.
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