scholarly journals Effect of alirocumab on coronary plaque in patients with coronary artery disease assessed by optical coherence tomography

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Fei Gao ◽  
Zhi Jian Wang ◽  
Xiao Teng Ma ◽  
Hua Shen ◽  
Li Xia Yang ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Standard Care ◽  
Ldl Cholesterol ◽  
Randomized Study ◽  
Coronary Plaque ◽  
Optical Coherence ◽  
Pcsk9 Inhibitors ◽  
Open Label ◽  
Cholesterol Levels ◽  
The Impact

Abstract Background Proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors have been demonstrated to produce significantly greater reduction in LDL cholesterol levels and cardiovascular events than standard statin therapy. However, evidence on the impact of PCSK9 inhibitors on coronary plaque composition and morphology is limited. Methods In this open-label randomized study, eligible patients with intermediate coronary lesions and elevated LDL cholesterol values were randomized to either alirocumab 75 mg Q2W plus statin (atorvastatin 20 mg/day or rosuvastatin 10 mg/day) therapy or standard care. Optical coherence tomography (OCT) assessments for target lesions were obtained at baseline and at 36 weeks of follow-up. Results LDL cholesterol levels were significantly decreased in both the alirocumab and standard care arms, whereas the absolute reduction in LDL cholesterol was significantly greater in patients treated with alirocumab (1.72 ± 0.51 vs. 0.96 ± 0.59, P < 0.0001). Compared with standard care, the addition of alirocumab to statins was associated with significantly greater increases in minimum fibrous cap thickness (18.0 [10.8–29.2] μm vs 13.2 [7.4–18.6] μm; P = 0.029), greater increases in minimum lumen area (0.20[0.10–0.33] mm2 vs 0.13 [0.12–0.24] mm2; P = 0.006) and a greater diminution in maximum lipid arc (15.1̊ [7.8–24.5] vs. 8.4̊ [2.0–10.5]; P = 0.008). Conclusions The addition of alirocumab to statins can not only provide additional LDL cholesterol lowering effects but also have a potential role in promoting a more stable plaque phenotype. Trial registration ClinicalTrials.gov Identifier: NCT04851769. Registered 2 Mar 2019.

scholarly journals Effect of Alirocumab on Coronary Plaque in Patients With Coronary Artery Disease Assessed by Optical Coherence Tomography

2021 ◽  
Author(s):  
Fei Gao ◽  
Zhi Jian Wang ◽  
Xiao Teng Ma ◽  
Hua Shen ◽  
Li Xia Yang ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Statin Therapy ◽  
Standard Care ◽  
Ldl Cholesterol ◽  
Randomized Study ◽  
Coronary Plaque ◽  
Optical Coherence ◽  
Pcsk9 Inhibitors ◽  
Cholesterol Levels ◽  
The Impact

Abstract Background Proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors have been demonstrated with significant greater reduction of LDL cholesterol levels and cardiovascular events, compared with standard statin therapy. However, the evidence on the impact of PCSK9 inhibitors on coronary plaque composition and morphology are limited. Methods In this prospective, open-label, randomized study, eligible patients with intermediate coronary lesions and elevated LDL cholesterol values were randomized to either alirocumab 75 mg Q2W plus statin therapy (alirocumab arm) or statin therapy (standard care arm). Optical coherence tomography (OCT) assessment for target lesions were obtained at the baseline and at 36 weeks of follow-up. Results LDL cholesterol levels were significantly decreased in both alirocumab arm and standard care arm, whereas the absolute reduction of LDL cholesterol was significantly greater in patients with alirocumab (1.72±0.51 vs 0.96±0.59, P<0.0001). Compared with standard statin therapy, the addition of alirocumab to statins was associated with significant greater increase in minimum fibrous cap thickness (18.0 [10.8- 29.2]um vs 13.2 [7.4-18.6]um; P=0.029), minimum lumen area (0.20[ 0.10-0.33]mm 2 vs 0.13 [0.12-0.24]mm 2 ; P=0.006) and greater diminution in maximum lipid arc (15.1 ̊ [7.8 -24.5] vs. 8.4 ̊ [2.0 -10.5]; P=0.008). Conclusions The addition of alirocumab to statins can not only provide additional LDL cholesterol lowering effect but also have a potential role in promoting a more stable plaque phenotype.

P6154Association between n-3 and n-6 polyunsaturated fatty acids and plaque vulnerability by optical coherence tomography in acute myocardial infarction patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N Kanehama ◽  
S Kimura ◽  
T Kawakami ◽  
R Tateishi ◽  
S Tachibana ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Fatty Acids ◽  
Optical Coherence Tomography ◽  
Polyunsaturated Fatty Acids ◽  
Cardiovascular Events ◽  
Ldl Cholesterol ◽  
Coronary Plaque ◽  
Optical Coherence ◽  
Plaque Vulnerability

Abstract Background The values of n-3 and n-6 polyunsaturated fatty acids (PUFAs) like low eicosapentaenoic acid (EPA) /arachidonic acid (AA) ratio are known to be associated with cardiovascular events, however their relationship with coronary plaque vulnerability in acute myocardial infarction (AMI) is not revealed. Purpose We evaluated the relationship between n-3 and n-6 PUFAs and coronary plaque vulnerability assessed by optical coherence tomography (OCT) in AMI patients. Methods We investigated 79 AMI lesions (51 ST elevated myocardial infarction (STEMI) lesions and 28 non-STEMI lesions) that had undergone emergency percutaneous coronary intervention using OCT. Coronary plaque characteristics by OCT were compared with n-3 and n-6 PUFAs values which were measured on admission. Results Of all AMI lesions (n=79), 43 thin-cap fibroatheroma (TCFA) and 35 plaque rapture (PR) were detected by OCT. Lesions with TCFA had no significant relationship with n-3 and n-6 PUFAs values, whereas lesion with PR had significantly lower EPA values than those without (55.8±29.5 vs 74.3±37.1 μg/ml, p=0.018). Median low-density lipoprotein (LDL) cholesterol value was 117 (98–137) mg/dl and sub-analysis in patients who had lower LDL cholesterol values than median (n=39) revealed that EPA values were significantly lower in lesions with TCFA (56.3±30.9 vs 85.3±47.7 μg/ml, p=0.03). In STEMI patients, the values of EPA and EPA/AA ratio were significantly lower in lesions with TCFA (EPA: 55.5±22.8 vs 80.8±46.1 μg/ml, p=0.01; EPA/AA ratio: 0.34±0.16 vs 0.50±0.36, p=0.03). STEMI patients who had lower LDL cholesterol values <114 mg/dl of median (n=26), the values of EPA, EPA/AA ratio, and EPA+ docosahexaenoic acid (DHA) /AA ratio were significantly lower in lesions with TCFA (EPA: 51.4±20.7 vs 93.1±53.0 μg/ml, p=0.01; EPA/AA ratio: 0.37±0.16 vs 0.67±0.41, p=0.01; EPA+DHA/AA ratio: 1.13±0.41 vs 1.63±0.76, p=0.04). In STEMI patients with lower LDL cholesterol values, EPA/AA ratio positively correlated with fibrous cap thickness (Spearman, ρ=0.35, p=0.08). The cutoff value of EPA/AA ratio predicting the existence of TCFA was 0.52 (area under the curve 0.78, sensitivity 93.8%, specificity 70.0%, p=0.02). Conclusion This study demonstrated that n-3 and n-6 PUFAs values were associated with coronary plaque vulnerability by OCT in AMI patients, especially in STEMI. These results suggest that n-3 and n-6 PUFAs may be residual risk markers of severe acute cardiovascular events in patients with low LDL cholesterol values.

Abstract 383: Patient-Specific Coronary Models Combining Intravascular Ultrasound and Optical Coherence Tomography Lead to More Accurate Plaque Cap Thickness and Stress/Strain Quantifications

2017 ◽  
Vol 37 (suppl_1) ◽  
Author(s):  
Xiaoya Guo ◽  
David Monoly ◽  
Chun Yang ◽  
Habib Samady ◽  
Jie Zheng ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Intravascular Ultrasound ◽  
Coronary Plaque ◽  
Patient Specific ◽  
Data Sets ◽  
Optical Coherence ◽  
Stress Strain ◽  
Data Set ◽  
The Impact

Accurate cap thickness and stress/strain quantifications are of fundamental importance for vulnerable plaque research. An innovative modeling approach combining intravascular ultrasound (IVUS) and optical coherence tomography (OCT) is introduced for more accurate patient-specific coronary morphology and stress/strain calculations. In vivo IVUS and OCT coronary plaque data were acquired from two patients with informed consent obtained. IVUS and OCT images were segmented, co-registered, and merged to form the IVUS+OCT data set, with OCT providing accurate cap thickness. Biplane angiography provided 3D vessel curvature. Due to IVUS resolution (150 μm), original virtual histology (VH) IVUS data often had lipid core exposed to lumen since it sets cap thickness as zero when cap thickness <150 μm. VH-IVUS data were processed with minimum cap thickness set as 50 and 180 μm to generate IVUS50 and IVUS180 data sets for modeling use. 3D fluid-structure interaction models based on IVUS+OCT, IVUS50 and IVUS180 data sets were constructed to investigate the impact of OCT cap thickness improvement on stress/strain calculations. Figure 1 is a brief summary of results from 27 slices with cap covering lipid cores from 2 patients. Mean cap thickness (unit: mm) from Patient 1 was 0.353 (OCT), 0.201 (IVUS50), and 0.329 (IVUS180), respectively. Patient 2 mean cap thickness was 0.320 (OCT), 0.224 (IVUS50), and 0.285 (IVUS180). IVUS50 underestimated cap thickness (27 slices) by 34.5%, compared to OCT cap values. IVUS50 overestimated mean cap stress (27 slices) by 45.8%, compared to OCT cap stress (96.4 vs. 66.1 kPa). IVUS50 maximum cap stress was 59.2% higher than that from IVUS+OCT model (564.2 vs. 354.5 kPa). Differences between IVUS and IVUS+OCT models for mean cap strain and flow shear stress were modest (cap strain: <12%; FSS <2%). Conclusion: IVUS+OCT data and models could provide more accurate cap thickness and stress/strain calculations which will serve as basis for plaque research.

scholarly journals The role of optical coherence tomography guidance in scaffold versus stent optimization

2020 ◽  
Vol 72 (1) ◽  
Author(s):  
Arif A. Al Nooryani ◽  
Nagwa A. Abdelrahman ◽  
Hatem A. Helmy ◽  
Yehia T. Kishk ◽  
Ayman K. M. Hassan
Keyword(s):  
Decision Making ◽  
Optical Coherence Tomography ◽  
Coronary Intervention ◽  
Drug Eluting Stents ◽  
Optical Coherence ◽  
Total Rate ◽  
Great Ability ◽  
Bioresorbable Scaffolds ◽  
Drug Eluting ◽  
The Impact

Abstract Background Optical coherence tomography showed a great ability to identify adverse features during percutaneous coronary intervention with drug-eluting stents and resulted in better clinical outcomes. The study aimed to assess the impact of optical coherence tomography on intraoperative decision-making during implantation of Absorb bioresorbable scaffolds versus everolimus drug-eluting stents. Results We performed an observational study that included 223 consecutive patients post optical coherence tomography-guided implantation of either Absorb bioresorbable scaffolds (162 patients) or everolimus drug-eluting stents (61 patients). We studied the influence of optical coherence tomography on intraoperative decision-making during implantation of bioresorbable scaffolds versus drug-eluting stents by analyzing the total rate of optical coherence tomography-dependent modifications in each device. After satisfactory angiographic results, the total rate of required intervention for optical coherence tomography detected complications was significantly higher in the bioresorbable scaffolds arm compared to drug-eluting stents arm (47.8% versus 32.9%, respectively; p = 0.019). The additional modifications encompassed further optimization in the case of device underexpansion or struts malapposition, and even stenting in the case of strut fractures, or significant edge dissection. Conclusions Compared to drug-eluting stents, Absord scaffold was associated with a significantly higher rate of optical coherence tomography-identified intraprocedural complications necessitating further modifications. The study provides some hints on the reasons of scaffolds failure in current PCI practice; it offers a new insight for the enhancement of BRS safety and presents and adds to the growing literature for successful BRS utilization.

Assessment of coronary plaque collagen with polarization sensitive optical coherence tomography (PS-OCT)

2006 ◽  
Vol 107 (3) ◽  
pp. 400-409 ◽  
Author(s):  
Susanne D. Giattina ◽  
Brian K. Courtney ◽  
Paul R. Herz ◽  
Michelle Harman ◽  
Sonya Shortkroff ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Coronary Plaque ◽  
Optical Coherence
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