Circulating chemokines in relation to coronary plaque characteristics as measured by intravascular ultrasound and 1-year cardiovascular outcome in patients undergoing coronary angiography

Purpose: To investigate the relations of several circulating chemokines with the extent and phenotype of coronary atherosclerosis as determined in-vivo by intravascular ultrasound (IVUS) and with 1-year clinical outcome. Methods: IVUS of a non-culprit coronary artery was performed in 570 patients who underwent coronary angiography for acute coronary syndrome (ACS) (n=309) or stable angina pectoris (SAP) (n=261). Subsequent events during 1-year follow-up were adjudicated to be either culprit lesion-related (n=11), non-culprit lesion related (n=27) or indeterminate (n=18). Results: Higher plasma monocyte chemoattractant protein-1 (MCP-1) (p=0.002 in SAP patients), macrophage inflammatory protein-1α (MIP-1α) (p=0.001) and lower Regulated And Normal T cell Expressed and Secreted (RANTES) (p=0.025 in ACS patients) were associated with higher plaque burden (Figure A). Higher MCP-1 (p=0.045 in SAP patients) and MIP-1α (p=0.021) were associated with higher necrotic core fraction. Higher MCP-1 (p=0.052 in SAP patients), higher MIP-1α (p=0.021) and lower RANTES (p=0.067) tend to be associated with the presence of IVUS-derived thin-cap fibroatheroma (TCFA) lesions (Figure B). RANTES was independently associated with the composite endpoints of non-culprit related or indeterminate all-cause mortality, ACS or coronary revascularization (HR per SD ln-RANTES 0.71, 95% CI 0.53-0.96) and all-cause mortality or ACS only (HR per SD ln-RANTES 0.64, 95% CI 0.44-0.94) (Figure C). Figure 1. RANTES, plaque phenotype and outcome Figure 1. RANTES, plaque phenotype and outcome Conclusions: Higher plasma MCP-1, MIP-1α, and lower RANTES concentrations are associated with a higher plaque burden, a more advanced phenotype and a higher vulnerability of coronary atherosclerosis. RANTES is a promising biomarker that is independently, inversely associated with occurrence of cardiac events, particularly of death and ACS.