Effects of 4 Statins on Regression of Coronary Plaque in Acute Coronary Syndrome

Introduction: IMPROVE-IT trial showed that ezetimibe plus statin treatment, as compared with statin alone, decreased cardiovascular events in patients with acute coronary syndrome (ACS). However, proir studies have failed to show a beneficial effect of ezetimibe on carotid plaque progression when added to statin treatment. Hypothesis: The addition of ezetimibe to statin therapy affects coronary plaque behavior in the non-culprit vessel. Methods: We conducted a prospective, randomized open-label parallel group study with blind endpoint evaluation conducted at 10 centers in Japan. A total of 128 statin naïve patients with ACS undergoing intravascular ultrasound (IVUS) guided percutaneous coronary intervention were randomized and nonculprit coronary lesions associated with mild-to-moderate stenosis in 103 patients had evaluable IVUS examinations at baseline and at 8 to 12 months follow-up. Conventional IVUS and integrated backscatter (IB)-IVUS measurements at 1-mm intervals were calculated. Patients were randomly assigned to receive either 2mg/day of pitavastatin plus 10mg/day ezetimibe or 2mg/day of pitavastatin. Primary endpoints were the percentage change in non-culprit coronary plaque volume and percent change in lipid plaque volume. Results: Mean low density lipoprotein cholesterol was reduced from 125mg/dl to 65mg/dl in the combination therapy group receiving statin plus ezetimibe (n=50) and 126mg/dl to 87 mg/dl in the statin alone group (n=53)(between group difference of 16.9%, P<0.0001). Length of analyzed segment did not differ between the groups (median 38.0 vs. 41.2 mm, p=0.40). The primary endpoint, percent change in plaque volume, was -5.1% in the combination therapy group and -6.2% in the statin alone group (P=0.66), although both groups resulted in reduction of plaque volume compared with baseline (both p=0.001). The percent change in lipid plaque volume did not differ between the groups (4.3 vs. -3.0%, P=0.37). Conclusions: Among patients with acute coronary syndrome, combined therapy with ezetimibe and statin did not result in a significant change in coronary plaque regression or tissue component compared with statin alone.

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Association between Tissue Characteristics of Coronary Plaque and Distal Embolization after Coronary Intervention in Acute Coronary Syndrome Patients: Insights from a Meta-Analysis of Virtual Histology-Intravascular Ultrasound Studies

PLoS ONE ◽

10.1371/journal.pone.0106583 ◽

2014 ◽

Vol 9 (11) ◽

pp. e106583 ◽

Cited By ~ 7

Author(s):

Song Ding ◽

Longwei Xu ◽

Fan Yang ◽

Lingcong Kong ◽

Yichao Zhao ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Intravascular Ultrasound ◽

Meta Analysis ◽

Coronary Intervention ◽

Coronary Plaque ◽

Distal Embolization ◽

Ultrasound Studies ◽

Virtual Histology ◽

Coronary Syndrome ◽

Tissue Characteristics

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Age- and sex-related differences in coronary plaque high-risk features in patients with acute coronary syndrome assessed by computed tomography angiography

International Journal of Cardiology ◽

10.1016/j.ijcard.2014.04.089 ◽

2014 ◽

Vol 174 (3) ◽

pp. 744-747 ◽

Cited By ~ 5

Author(s):

Toshiro Kitagawa ◽

Hideya Yamamoto ◽

Yoji Urabe ◽

Hiroshi Tsushima ◽

Hiroto Utsunomiya ◽

...

Keyword(s):

Computed Tomography ◽

Acute Coronary Syndrome ◽

High Risk ◽

Computed Tomography Angiography ◽

Coronary Plaque ◽

Coronary Syndrome ◽

Age And Sex

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Preliminary Pilot Study of Combined Effects of Physical Activity and Achievement of LDL-Cholesterol Target on Coronary Plaque Volume Changes in Patients with Acute Coronary Syndrome

Journal of Clinical Medicine ◽

10.3390/jcm9051578 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1578

Author(s):

Miho Nishitani-Yokoyama ◽

Katsumi Miyauchi ◽

Kazunori Shimada ◽

Takayuki Yokoyama ◽

Shohei Ouchi ◽

...

Keyword(s):

Physical Activity ◽

Acute Coronary Syndrome ◽

Combined Therapy ◽

Study Groups ◽

Coronary Plaque ◽

Combined Effects ◽

Plaque Volume ◽

Coronary Syndrome ◽

Coronary Plaque Volume

Background: We investigated the combined effects of physical activity (PA) and aggressive low-density lipoprotein cholesterol (LDL-C) reduction on the changes in coronary plaque volume (PV) in patients with acute coronary syndrome (ACS) using volumetric intravascular ultrasound (IVUS) analysis. Methods: We retrospectively analyzed data from two different prospective clinical trials that involved 101 ACS patients who underwent percutaneous coronary intervention (PCI) and assessed the non-culprit sites of PCI lesions using IVUS at baseline and at the follow-up. After PCI, all the patients participated in early phase II comprehensive cardiac rehabilitation. Patients were divided into four groups based on whether the average daily step count, measured using a pedometer, was 7000 steps of more and whether the follow-up LDL-C level was <70 mg/dL. At the time of follow-up, we examined the correlation of changes in the PV with LDL-C and PA. Results: The baseline characteristics of the four study groups were comparable. At the follow-up, plaque regression in both the achievement group (PA and LDL-C reduction) was higher than that in the other three groups. In addition, plaque reduction independently correlated with increased PA and reduction in LDL-C level. Conclusions: Combined therapy of intensive PA and achievement of LDL-C target retarded coronary PV in patients with ACS.

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Effect of postprandial hyperglycaemia on culprit plaque rupture in diabetic patients with non-ST segment elevation acute coronary syndrome

European Heart Journal ◽

10.1093/ehjci/ehaa946.1570 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

G Su ◽

S.W Zhuang ◽

T Zhang ◽

H.X Yang ◽

W.L Dai ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Hemoglobin A1c ◽

Plaque Rupture ◽

Coronary Plaque ◽

Postprandial Hyperglycemia ◽

Diabetic Patients ◽

Funding Source ◽

St Segment Elevation ◽

Coronary Syndrome ◽

St Segment

Abstract Background Postprandial hyperglycemia was reported to play a key role in established risk factors of coronary artery diseases (CAD) and cardiovascular events. Serum 1,5-anhydroglucitol (1,5-AG) levels are known to be a clinical marker of postprandial hyperglycemia and short-term glycemic excursions. Low serum 1,5-AG levels have been associated with occurrence of CAD; however, the relationship between 1,5-AG levels and coronary plaque rupture has not been fully elucidated. The aim of this study was to evaluate 1,5-AG as a predictor of coronary plaque rupture in diabetic patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS). Methods A total of 132 diabetic patients with NSTE-ACS were included in this study. All patients underwent intravascular ultrasound examination, which revealed 38 patients with plaque rupture and 94 patients without plaque rupture in the culprit lesion. Fasting blood glucose (FBS), hemoglobin A1c (HbA1c) and 1,5-AG levels were measured before coronary angiography. Fasting urinary 8-iso-prostaglandin F2α (8-iso-PGF2α) level was measured and corrected by creatinine clearance. Results Patients with ruptured plaque had significantly lower serum 1,5-AG levels and a tendency of higher hemoglobin A1c levels than patients without ruptured plaque in our study population. In multivariate analysis, low 1,5-AG levels were an independent predictor of plaque rupture (odds ratio 3.3; p=0.006) in diabetic patients with NSTE-ACS, but HbA1c was not. The area under the receiver-operating characteristic curve for 1,5-AG (0.678, p=0.001) to predict plaque rupture was superior to that for HbA1c (0.618, p=0.034). Levels of 1,5-AG were significantly correlated with urinary 8-iso-PGF2α (r=−0.224, p=0.010). Conclusions Postprandial hyperglycaemia appeared to be superior to long-term average blood glucose levels in predicting plaque rupture in culprit lesions, which may be useful to assess the cardiovascular outcomes in diabetic patients. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Outstanding Clinical Discipline Project of Shanghai Pudong, Beijing Health Special Foundation

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Multi-Imaging Investigation to Evaluate the Relationship between Serum Cystatin C and Features of Atherosclerosis in Non-ST-Segment Elevation Acute Coronary Syndrome

Applied Sciences ◽

10.3390/app9040657 ◽

2019 ◽

Vol 9 (4) ◽

pp. 657

Author(s):

Nevio Taglieri ◽

Cristina Nanni ◽

Gabriele Ghetti ◽

Rachele Bonfiglioli ◽

Francesco Saia ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Coronary Plaque ◽

Plaque Vulnerability ◽

St Segment Elevation ◽

Fdg Uptake ◽

Coronary Syndrome ◽

St Segment ◽

Multivariable Analyses ◽

18F Fdg ◽

Elevation Acute Coronary Syndrome

Objectives: High cystatin C(CysC) levels are associated with impaired cardiovascular outcome. Whether CysC levels are independently related to the atherosclerosis burden is still controversial. Methods: We enrolled 31 non-ST-segment elevation acute coronary syndrome patients undergoing percutaneous coronary intervention. Patients were divided into 2 groups on the basis of median value of serum CysC. Using the high CysC group as a dependent variable, univariable and multivariable analyses were used to evaluate the association between CysC and three different features of atherosclerosis: 1) coronary plaque vulnerability as assessed by optical coherence tomography (OCT), 2) coronary artery calcium (CAC) by means of computed tomography scan, and 3) aortic wall metabolic activity, as assessed using 18F-Fluorodeoxyglucose-positron emission tomography (18F-FDG-PET). Results: After univariable and multivariable analyses, 18F-FDG uptake in the descending aorta (DA) was independently associated with a low level of CysC [(Odds Ratio = 0.02; 95%CI 0.0004–0.89; p = 0.044; 18F-FDG uptake measured as averaged maximum target to blood ratio); (Odds Ratio = 0.89; 95%CI 0.82–0.98, p = 0.025; 18F-FDG uptake measured as number of active slices)]. No trend was found for the association between CysC and characteristics of OCT-assessed coronary plaque vulnerability or CAC score. Conclusions: In patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS), 18F-FDG uptake in the DA was associated with a low level of serum CysC. There was no relation between CysC levels and OCT-assessed coronary plaque vulnerability or CAC score. These findings suggest that high levels of CysC may not be considered as independent markers of atherosclerosis.

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