Investigation on Multi-biomarker Strategy by novel coronary imagings

本研究旨在开发冠状动脉疾病的多生物标志物策略，通过结合新型冠状动脉成像（冠状动脉血管镜、血管内超声和光学相干断层扫描）和心血管生物标志物，揭示了有关斑块组织和纤维帽成分的详细分析的重要性。在冠状动脉支架植入术（BMS与DES）后的新冠状动脉成像中的连续观察表明，BMS与DES之间的新生内膜形成存在显著差异，特别是DES再狭窄部位新生血管微通道的形成，这表明有必要开发更多反映新生血管形成的新标记物。作为斑块易损性最上游的新型生物标志物，本研究证明了sLOX-1、MMP-9、MPO、高敏肌钙蛋白T和NT-proBNP的组合的有用性。这些评估和OCT分析显示，即使在稳定型冠状动脉疾病患者中，经皮冠状动脉介入术后围手术期心肌损伤的高危斑块的患病率也很高，其主要特征是OCT显示的罪犯病变处的脂质斑块角度较大，纤维帽较薄，即无症状易损斑块或上游易损斑块。

The present investigation for the development of multi-biomarker strategy in coronary artery disease revealed importance of the detail analyses concerning the plaque tissue and fibrous cap components by the combination of novel coronary imaging (coronary angioscope, intravascular ultrasound, and optical coherence tomography) and cardiovascular biomarkers. Sequential observation in novel coronary imaging following the coronary stent implantation (BMS versus DES) demonstrated marked differences in the neointimal formation between BMS and DES, especially the development of neovascular microchannels in DES restenosis site, which should suggest the necessity of the development of further new marker reflecting neovascular formation. As the novel biomarker for the most upstream of plaque vulnerability, the present investigation demonstrated usefulness of the combination of sLOX-1, MMP-9, MPO,high-sensitivity troponin T and NT-proBNP. These assessment and OCT analysis revealed high prevalence of high-risk plaque for peri-procedural myocardial injury following percutaneous coronary intervention even in patients with stable coronary artery disease, which was mostly characterized by larger angle of lipid plaque and thinner fibrous cap at the culprit lesion by OCT, namely, silent vulnerable plaque or the upstream vulnerable plaque.