Investigation on Multi-biomarker Strategy by novel coronary imagings

目前冠状动脉疾病多生物标志物策略的研究表明，结合新型冠状动脉成像(冠脉镜、血管内超声和光学相干断层扫描)和心血管生物标志物，对斑块组织和纤维帽成分进行详细分析的重要性。冠状动脉支架置入术后新的冠状动脉成像(BMS和DES)的序贯观察显示，BMS和DES在新的内膜形成方面存在显著差异，尤其是在DES再狭窄处新的血管微通道的形成，这提示有必要进一步开发新的反映新血管形成的标志物。作为斑块易损性最上游的新生物标志物，本研究证实了sLOX-1、MMP-9、MPO、高敏感性肌钙蛋白T和NT-proBNP的联合应用。这些评估和OCT分析显示，即使在稳定性冠状动脉疾病患者中，经皮冠状动脉介入治疗后围术期心肌损伤的高危斑块的发生率也很高，其主要特征是OCT显示的罪魁祸首病变处的脂斑角更大，纤维帽更薄，即沉默的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.