Serum fibrinogen level and platelet-to-lymphocyte ratio as predictors of vulnerable atherosclerotic plaque formation in coronary arteries in patients with coronary artery disease and arterial hypertension

Objective. It is well-established that rupture of lipid-rich atherosclerotic lesions in the coronary arteries (referred to as vulnerable, high-risk, or unstable plaques) with subsequent coronary artery thrombosis is the most common cause of acute coronary syndrome and sudden cardiac death. Vulnerable plaques are most accurately detected using optical coherence tomography (OCT). Given the high cost of OCT, an urgent task is to search for markers of the development of vulnerable atherosclerotic plaques in the coronary arteries based on routine examination data, which will allow developing effective strategies for the prevention of associated coronary events. In hypertensive patients potential markers may include indicators of systemic inflammation, but little information is available on this topic.

Aim: To identify potential markers of vulnerable atherosclerotic plaques in coronary arteries in patients with stable coronary artery disease and hypertension based on routine laboratory testing.

Material and Methods. The study included patients >18 years old, with a diagnosis of stable coronary artery disease and indications for OCT-guided PCI (extended/calcified/bifurcation lesions and/or diabetes), who gave informed consent to participate in the study. All patients underwent laboratory and instrumental examination in accordance with approved standards of medical care. A total of 30 patients were included in the study: aged 66.5±9.2 years (including 17 men); office BP 134.4±12.4/78.3±6.05 mmHg (systolic, SBP/ diastolic, DBP, respectively); type 2 diabetes mellitus (DM2) was detected in 30%; body mass index was 30.7±5.3 kg/m2.

Results. According to OCT data, patients were divided into two groups: group 1 (n = 19) with the presence of vulnerable atherosclerotic plaque morphology (rich lipid core, lipid plaque with lipid arc expansion>180°, presence of macrophage clusters) and group 2 (n = 11) with atherosclerotic plaques without signs of vulnerability. The groups were comparable in terms of gender, age, blood pressure, antihypertensive, hypoglycemic and lipid-lowering therapy. However, patients in group 1 had statistically significantly higher levels of fibrinogen (3.39±0.86 vs. 2.75±0.45, p = 0.038), platelet-lymphocyte ratio (119.2±31.9 vs. 84.0±30, p = 0.006) and blood creatinine (88.3±13.2 vs. 76.7±7.8, p = 0.014). According to multivariate logistic regression analysis, blood fibrinogen and plateletlymphocyte ratio were independent markers of the presence of vulnerable atherosclerotic plaques.

Conclusion. Platelet-lymphocyte ratio and blood fibrinogen levels, determined as part of a routine examination and reflecting increased activity of systemic inflammation, are markers of the development of vulnerable atherosclerotic plaques in the coronary arteries in patients with stable coronary artery disease and hypertension.

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