摘要：Resumen Fundamento. Las placas ateroscleróticas que producen la mayoría de los síndromes coronarios agudos al romperse son los fibroateromas de cápsula fina, denominados placas vulnerables. Éstas pueden ser detectadas únicamente con técnicas invasivas de imagen intracoronaria. Es preciso encontrar un biomarcador no invasivo que permita identificar a los pacientes con estas placas sin necesidad de cateterismo cardiaco. La metaloproteinasa-1 es una enzima involucrada en el metabolismo de la matriz extracelular que ha sido relacionada con la ruptura de las placas ateroscleróticas. Se desconocen sus niveles séricos en pacientes con placas vulnerables. Material y métodos. Se incluyeron pacientes sometidos a cateterismo cardiaco por enfermedad coronaria estable. Se estudiaron las arterias coronarias con tomografía de coherencia óptica para detectar placas vulnerables. Se extrajeron muestras de sangre periférica y del seno coronario para analizar la concentración de metaloproteinasa-1. Resultados. Se incluyeron 51 pacientes. Trece tenían al menos un fibroateroma de cápsula fina. No se encontraron diferencias significativas en las características clínicas, perfil lipídico ni proteína C reactiva entre los pacientes con y sin placas vulnerables. Los pacientes con placas vulnerables presentaron concentraciones significativamente mayores de metaloproteinasa-1, tanto en sangre periférica (7330±5541 vs 2894±1783 pg/ml, p=0,025) como en seno coronario (6012±3854 vs 2707±1252 pg/ml, p=0,047). Conclusiones. Los pacientes con placas vulnerables presentaron niveles séricos significativamente mayores de metaloproteinasa-1. Se requieren estudios con seguimiento clínico para evaluar el valor pronóstico de la metaloproteinasa-1 sérica.
其他摘要：Abstract Background. Most acute coronary syndromes are caused by the fracture of a vulnerable atherosclerotic plaque. These plaques are thin cap fibroatheromas, which can only be detected with invasive coronary imaging techniques. It is necessary to find a non-invasive biomarker of these vulnerable plaques in order to identify patients at risk without a coronary angiography. Metalloproteinase-1 is an enzyme involved in extracellular matrix metabolism which has been correlated with the rupture of atherosclerotic plaques. Its serum levels in patients with vulnerable plaques remain unknown. Methods. Patients with suspected stable coronary artery disease undergoing coronary angiography in our hospital were included. The coronary arteries were studied with optical coherence tomography to detect vulnerable plaques. Blood samples were taken from a peripheral vein and from the coronary sinus, to assess metalloproteinase-1 levels. Results. Fifty-one patients were included, 13 of whom had at least one vulnerable plaque. There were not significant differences in clinical characteristics, lipid profile or C reactive protein levels, between patients with or without vulnerable plaques. Patients with vulnerable plaques had significant higher metalloproteinase-1 levels both in peripheral (7330±5541 vs 2894±1783 pg/ml, p=0.025) and coronary sinus serum (6012±3854 vs 2707±1252 pg/ml, p=0.047). Conclusions. Patients with vulnerable plaques had significantly higher metalloproteinase-1 serum levels. Further studies with clinical follow up are needed to assess the prognostic value of serum metalloproteinase-1.
关键词：Placa vulnerable;Fibroateroma de cápsula fina;Biomarcador;Metaloproteinasa-1;Síndrome coronario agudo
其他关键词：Vulnerable plaque;Thin cap fibroatheroma;Biomarker;Metalloproteinase-1;Acute coronary syndrome
