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Relationship between hs-CRP-triglyceride glucose index and coronary plaque morphology: insights from optical
Hongying Yao1, Qianyun Guo2, Qian Ma3
1Department of Cardiology, Peking University International Hospital, Beijing, 102206, China.
Insights
The high-sensitivity C-reactive protein-triglyceride-glucose index (CTI) is associated with vulnerable plaque features in acute coronary syndrome (ACS) patients. Elevated CTI predicts increased risk of healed and vulnerable plaques, outperforming other single factors in discrimination.
Area of Science:
- Cardiology
- Biomarkers
- Vascular Biology
Background:
- Coronary plaque morphology is critical in determining acute cardiovascular events.
- The high-sensitivity C-reactive protein-triglyceride-glucose index (CTI) correlates with cardiovascular events and mortality.
- The relationship between CTI and detailed plaque morphology via optical coherence tomography (OCT) remains uninvestigated.
Purpose of the Study:
- To investigate the association between the CTI and detailed coronary plaque morphology.
- To evaluate the discriminative ability of CTI for identifying vulnerable plaques using OCT.
- To explore associations stratified by clinical presentation (stable angina pectoris vs. acute coronary syndrome).
Main Methods:
- Retrospective cross-sectional study of 444 coronary artery disease patients undergoing OCT before percutaneous coronary intervention.
- Multivariable logistic regression models and stratified analyses were used to examine CTI and plaque morphology.
- Receiver operating characteristic (ROC) curve analysis assessed CTI's discriminative ability for vulnerable plaques.
Main Results:
- Higher CTI quartiles showed increased prevalence of macrophage accumulation and healed plaque.
- Elevated CTI was significantly associated with cholesterol crystals, multiple healed plaques, macrophage accumulation, and plaque rupture.
- Associations were significant in acute coronary syndrome (ACS) patients, with CTI demonstrating superior discriminative capacity for plaque vulnerability compared to single factors.
Conclusions:
- In ACS patients, elevated CTI is linked to an increased risk of healed and vulnerable plaques.
- A linear relationship exists between CTI and various lipid plaque-related parameters.
- CTI serves as a superior single factor for discriminating vulnerable plaque.
Background:
Accumulating evidence has underscored that coronary plaque morphology is the key determinant of acute cardiovascular events. The high-sensitivity C-reactive protein-triglyceride-glucose index (CTI) has been shown to correlate strongly with cardiovascular events and mortality. However, no previous study has investigated the relationship between CTI and detailed plaque morphological features evaluated using in vivo optical coherence tomography (OCT).
Methods:
In this retrospective cross-sectional study, 444 patients with coronary artery disease (CAD) who underwent OCT prior to percutaneous coronary intervention (PCI) were analyzed. The association between CTI and plaque morphology was examined employing multivariable logistic regression models. Stratified analyses according to clinical presentation (stable angina pectoris [SAP] vs. acute coronary syndrome [ACS]) and tests for interaction were further performed. Receiver operating characteristic (ROC) curve analysis was used to assess the discriminative ability of CTI for identifying vulnerable plaques.
Results:
The study revealed that participants divided into CTI quartiles exhibited a steadily rising prevalence of macrophage accumulation and healed plaque. Compared with the low CTI groups (Q1 and Q2), the incidences of cholesterol crystals and multiple healed plaques (≥ 2) were significantly higher in the high CTI groups (Q3 and Q4) (cholesterol crystals: 35.1% and 24.3% vs. 18.9% and 13.5%; multiple healed plaques: 18.9% vs. 12.6%). After accounting for the effects of different covariates, analyzing CTI as a continuous variable revealed a significant link to healed plaque (OR = 1.62, 95%CI:1.21-2.16, P = 0.001), cholesterol crystals (OR = 1.64, 95%CI:1.17-2.30, P = 0.004), macrophage accumulation (OR = 1.49, 95%CI:1.13-1.98, P = 0.005), and plaque rupture (OR = 1.54, 95%CI:1.07-2.21, P = 0.019). The statistically significant association persisted when CTI was split into quartiles. Notably, stratified analyses revealed that these significant associations were only present in patients with ACS. The RCS analysis demonstrated a linear association between CTI and various lipid plaque-related parameters. The area under the ROC curve (AUC) demonstrated that CTI exhibited a stronger correlation with plaque vulnerability compared with other single factors.
Conclusion:
In patients with ACS, elevated CTI is linked to an increased risk of healed plaque and vulnerable plaques. There is a linear relationship between CTI and various lipid plaque-related parameters. As a single factor, CTI provides a superior discriminative capacity for vulnerable plaque.
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