The relationship between atherogenic index of plasma and plaque vulnerabilities: an optical coherence tomography study

Background Atherogenic index of plasma (AIP) has been recommended as a marker of plasma atherogenicity. The impact of AIP on plaque characteristics is not fully understood. Purpose The study investigates the relationship between AIP and coronary plaque features in patients with acute coronary syndrome (ACS). Methods From January 2016 to June 2017 pre-intervention optical coherence tomography (OCT) was performed in 522 ACS patients. AIP was defined as the base 10 logarithm of the ratio of the concentrations of triglyceride to high-density lipoprotein cholesterol. Patients were divided into four groups according to AIP quartiles. Results A total of 332 patients were included for the analysis. The prevalence of thin-cap fibroatheroma (TCFA) (group I [lowest] 9.09% vs group II 16.5% vs group III 44.7% vs group IV [highest] 52.9%), macrophage accumulation (group I 18.2% vs group II 22.4% vs group III 31.8% vs group IV 47.1%), plaque rupture (group I 10.4% vs group II 14.1% vs group III 17.6% vs group IV 34.1%) and plaque erosion (group I 2.6% vs group II 2.4% vs group III 14.1% vs group IV 12.9%) were significantly different among AIP quartiles. Multivariate logistic regression revealed the risk of TCFA (odds ratio 11.130, 95% confidence interval 4.186-29.593, p < 0.001) and plaque rupture (OR 5.332, 95% CI 2.040-13.937, p < 0.001) increased in group IV compared to group I. Receiver operating characteristics curve showed the predictive value of AIP for TCFA and plaque rupture were 0.720 and 0.669 respectively. Conclusion(s)AIP is an independent predictor for vulnerable plaques beyond traditional factors. It can be integrated in clinical practice for risk stratification of ACS patients. Trial registration All patients gave their consent to participate in the study and the Ethics Committee of Beijing Anzhen Hospital, Capital Medical University approved it (2020047X).