Analysis Of Distribution Characteristics, Influencing Factors And Prognosis After Percutaneous Coronary Intervention Of Peripheral Blood Monocyte Subsets In Patients With Stable Coronary Artery Disease

BackgroundCardiovascular disease(CVD)is still the leading cause of death in China.Moreover,the incidence and prevalence of CVD such as coronary heart diseases are still steadily increasing.According to statistics,the incidence of stable coronary artery disease(SCAD)is twice that of myocardial infarction.The prevention and treatment of CVD such as SCAD face enormous challenges.The inflammatory response theory of atherosclerosis was proposed as early as the end of the last century,until the recent anti-inflammatory cardiovascular disease was confirmed.Monocytes and their heterogeneity play an important role in inflammation-induced atherosclerosis.Peripheral blood monocytes can be divided into three subsets by three-color flow cytometry,in which intermediate monocytes(IMs;CD14++CD16+)play a role in mediating proinflammatory responses.Current studies have confirmed that IMs are associated with atherosclerotic plaque,and most studies support that IMs are associated with poor prognosis of cardiovascular diseases.There is still a lack of research on the relationship between IMs,SCAD and its prognosis.The study will be divided into two parts: first,to explore the distribution characteristics of peripheral blood monocyte subsets and the factors affecting the distribution of IMs in SCAD patients.Second,to explore the effect of peripheral blood IMs ratio on the prognosis of patients with SCAD after PCI.ObjectiveThe distribution characteristics of peripheral blood monocyte subsets in patients with stable coronary artery disease(SCAD)by three-color flow cytometry and the factors affecting the distribution of intermediate monocyte subset were analyzed.And,to investigate the impact of peripheral blood intermediate monocytes(IMs,CD14++CD16+)on the prognosis in patients with stable coronary artery disease(SCAD)after percutaneous coronary intervention(PCI).MethodsPart1,this is a case-control study.Patients in total 162 were enrolled.96 patients with SCAD(SCAD group)and 66 patients with non-coronary artery disease(control group)were diagnosed according to clinical manifestations,laboratory tests,electrocardiogram and coronary angiography(CAG).Peripheral venous blood was taken from the patients in the morning on an empty stomach.The monocyte subsets were analyzed by a three-color flow cytometry and divided into classical monocytes(CMs;CD14++CD16-),intermediate monocytes(IMs;CD14++CD16+),and nonclassical monocytes(NCMs;CD14+CD16++).The clinical characteristics of the patients were recorded and analyzed statistically.Part2,this study was a prospective observational study.258 consecutive SCAD patients who underwent PCI in the First Affiliated Hospital of Chengdu Medical College from January to December 2017 were enrolled.Peripheral venous blood was taken from the patients in the morning on an empty stomach to analyze monocyte subsets by flow cytometry.According to the optimal cut-off IMs for all-cause death in SCAD patients after PCI,patients were divided into two groups.One-year prognosis was observed between the two groups.The primary end point was all-cause death,and the secondary end point was major adverse cardiac and cerebrovascular events(MACCE)and bleeding during hospitalization.ResultsPart1,The IMs ratio of SCAD group(9.42±3.32)was significantly higher than the control group(7.62±2.01)(P<0.05),whereas there was no significant difference between the two groups in CMs and NCMs.Multivariate logistic regression analysis suggested that IMs ratio was independently correlated with SCAD(OR=1.998,95%CI:1.122-4.355,P<0.05).Correlation analysis suggested that IMs was positively correlated with high-sensitivity C-reactive protein(hs-CRP)(r=0.859,P<0.01).The receiver operating characteristic(ROC)curve showed that IMs ratio predicted SCAD with a best cutoff value of 8.68%,sensitivity of 0.625,and specificity of 0.955.Part2,The ROC curve showed that the optimal cut-off IMs for all-cause death in SCAD patients after PCI was 10.37%(AUC=0.865,95%CI:0.783-0.924,P<0.01).The sensitivity was 71.43%,specificity was 87.63%.Based on the optimal cut-off value,the patients were divided into high IMs ratio group(IMs≥10.37)of 69 cases and low IMs ratio group(IMs<10.37)of 189 cases.Baseline and interventional data showed that the smoking,hypertension,multivessel disease and CTO ratio,age,LDL-C,hs-CRP,uric acid and other indicators were higher in high IMs ratio group than the low ratio group(P<0.01 or 0.05).The follow-up results showed that the incidence of all-cause death,MACCE,and cardiovascular death were higher in high IMs ratio group than the low ratio group(P<0.05),consistent with the Kaplan-Meier survival curve.Multivariate Cox regression analysis showed that the IMs ratio was independently related to all-cause death(HR=1.715,95%CI:1.342~2.643,P=0.032),MACCE(HR=2.136,95%CI:1.457~4.495,P=0.015),cardiovascular death(HR=1.382,95%CI:1.102~3.960,P=0.020).ConclusionPeripheral blood IMs ratio was closely related to SCAD and expected to be a predictor of SCAD.IMs ratio in peripheral blood has a certain predictive value for all-cause death and MACCE in SCAD patients after PCI.The relationship between IMs and SCAD and its prognosis may be related to the level of inflammatory factors such as hs-CRP.