Linking Systemic Inflammation to Coronary Lesion Complexity: A Combined FFR and OCT Study.

Area of Science:

• Cardiovascular Medicine
• Biomarkers
• Atherosclerosis Research

Background:

• Residual inflammation post-acute coronary syndrome (ACS) drives atherosclerosis progression and plaque instability.
• Key inflammatory biomarkers like interleukin-1 receptor antagonist (IL-1ra), resistin, and C-reactive protein (CRP) may indicate coronary lesion complexity and vulnerability.

Purpose of the Study:

• To assess the association between IL-1ra, resistin, and CRP levels with coronary disease extent, functional significance of non-culprit lesions (FFR), and plaque vulnerability (OCT-defined TCFA) in ACS patients.

Main Methods:

• Prospective study of 93 ACS patients undergoing invasive coronary assessment.
• Measured inflammatory biomarkers at admission and 6 months.
• Stratified patients into tertiles by biomarker levels.
• Assessed coronary disease extent (SYNTAX score), lesion significance (FFR), and plaque morphology (OCT-defined TCFA).
• Utilized multivariate logistic regression analysis.

Main Results:

• Higher tertiles of IL-1ra, resistin, and CRP correlated with increased SYNTAX scores, reduced FFR (<0.80), and higher prevalence of thin-cap fibroatheroma (TCFA).
• Specifically, 68% in the highest tertile had FFR < 0.80, and 62% had TCFA compared to 20% in lower tertiles.
• IL-1ra, resistin, and CRP independently predicted high-risk coronary profiles in multivariate models.

Conclusions:

• IL-1ra, resistin, and CRP are independently associated with coronary lesion complexity, functional significance, and vulnerability in ACS patients.
• Inflammatory biomarker profiling offers a complementary approach to anatomical and physiological assessments for ACS risk stratification.