Effects of Ezetimibe-Statin Combination Therapy on Coronary Atherosclerosis in Acute Coronary Syndrome

Diabetes mellitus (DM) is associated with more extensive coronary atherosclerosis and more vulnerable plaque phenotypes. However, DM should not be considered a homogeneous and purely binary entity in terms of risk assessment. We evaluated the impact of prediabetic status on coronary atherosclerosis burden in patients with first-time acute coronary syndrome (ACS) who underwent urgent coronary angiography. The patients were divided into DM, prediabetes, and control groups. The 3-vessel disease (TVD) rates and SYNTAX and Gensini scoring systems for defining atherosclerotic burden were compared. The study was conducted in 469 consecutive patients admitted with a diagnosis of ACS. Of these, 250 patients were admitted at the first occurrence of ACS undergoing diagnostic coronary angiography. SYNTAX and Gensini scores and TVD rates were higher in prediabetic patients than in nondiabetic patients ( P = .004, P = .008, and P = .014, respectively), but similar in prediabetic and diabetic patients ( P = .912, P = .773, and P = 1.000, respectively). Coronary atherosclerosis burden is more advanced in prediabetic patients than in nondiabetic patients and is comparable between prediabetic and diabetic patients at first presentation of ACS. Cardiologists should not miss the opportunity to diagnose prediabetes and DM when patients present with an ACS.

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Abstract 14134: Effects of Statin Plus Ezetimibe versus Statin Alone on Coronary Atherosclerosis in Acute Coronary Syndrome

Circulation ◽

10.1161/circ.132.suppl_3.14134 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Kiyoshi Hibi ◽

Kazuo Kimura ◽

Shinjo Sonoda ◽

Yutaka Otsuji ◽

Toyoaki Murohara ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Combination Therapy ◽

Therapy Group ◽

Combined Therapy ◽

Coronary Plaque ◽

Statin Treatment ◽

Combination Therapy Group ◽

Plaque Volume ◽

Coronary Syndrome ◽

Percent Change

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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Correlation between Serum High Sensitivity C-reactive Protein Level and Severity of Coronary Atherosclerosis Assessed by Angiographic Gensini Score in Patients with Acute Coronary Syndrome

Journal of Cardiovascular Medicine and Surgery ◽

10.21088/jcms.2454.7123.4218.5 ◽

2018 ◽

Vol 4 (2) ◽

pp. 100-107

Author(s):

Mayank Jain ◽

◽

Priyanka Kiyawat ◽

Surbhi Kiyawat ◽

◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Protein Level ◽

Coronary Atherosclerosis ◽

High Sensitivity ◽

Gensini Score ◽

C Reactive Protein ◽

Reactive Protein ◽

Coronary Syndrome

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Antithrombotic Therapy in Patients with Atrial Fibrillation and Acute Coronary Syndrome

Journal of Clinical Medicine ◽

10.3390/jcm9072020 ◽

2020 ◽

Vol 9 (7) ◽

pp. 2020

Author(s):

Wilbert Bor ◽

Diana A. Gorog

Keyword(s):

Atrial Fibrillation ◽

Acute Coronary Syndrome ◽

Combination Therapy ◽

Bleeding Risk ◽

Careful Consideration ◽

P2y12 Inhibitor ◽

Coronary Syndrome ◽

Antithrombotic Efficacy ◽

Selection Of ◽

Made In

Acute coronary syndrome and atrial fibrillation are both common and can occur in the same patient. Combination therapy with dual antiplatelet therapy and oral anticoagulation increases risk of bleeding. Where the two conditions coexist, careful consideration is needed to determine the optimal antithrombotic treatment to reduce the risks of future ischaemic events associated with both conditions. Choices can be made in intraprocedural anticoagulation, type and dosing of oral anticoagulant, duration of combination therapy, and selection of P2Y12 inhibitor including genetic testing. This review article provides an overview of the available evidence to support clinicians in finding the delicate balance between antithrombotic efficacy and bleeding risk in patients with acute coronary syndrome and atrial fibrillation.

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The Impact of Chronic Repetitive Leg Ischemia on Left Ventricular Function and Severity of Coronary Atherosclerosis in Patients with Acute Coronary Syndrome

Medical Principles and Practice ◽

10.1159/000481866 ◽

2017 ◽

Vol 26 (5) ◽

pp. 447-450

Author(s):

Mutlu Gungor ◽

Erkan Yildirim

Keyword(s):

Acute Coronary Syndrome ◽

Left Ventricular Function ◽

Ventricular Function ◽

Coronary Atherosclerosis ◽

Left Ventricular ◽

Coronary Syndrome ◽

The Impact ◽

Leg Ischemia

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Inhibition of the Renin-Angiotensin System Reduces the Rise in Serum Aldosterone in Acute Coronary Syndrome Patients with Preserved Left Ventricular Function: Observations from the AVANT GARDE-TIMI 43 Trial

Clinical Chemistry ◽

10.1373/clinchem.2012.199729 ◽

2013 ◽

Vol 59 (6) ◽

pp. 959-967 ◽

Cited By ~ 5

Author(s):

Jacob A Udell ◽

David A Morrow ◽

Eugene Braunwald ◽

Karl Swedberg ◽

Christoph Bode ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Combination Therapy ◽

Ventricular Function ◽

Natriuretic Peptides ◽

Left Ventricular ◽

Renin Angiotensin Aldosterone System ◽

Renin Angiotensin ◽

Avant Garde ◽

Coronary Syndrome ◽

Serum Aldosterone

BACKGROUND Acute coronary syndrome (ACS) activates neurohormonal pathways, including elevations in circulating aldosterone, with deleterious cardiovascular effects. We aimed to determine if early, more complete renin-angiotensin-aldosterone system inhibition (RAASI) in post-ACS patients without ventricular dysfunction or heart failure would result in a graded reduction in aldosterone concentrations. METHODS We performed serial measurement of serum aldosterone within the Aliskiren and Valsartan to Reduce NT-proBNP via Renin-Angiotensin-Aldosterone-System Blockade (AVANT GARDE)–Thrombolysis in Myocardial Infarction (TIMI) 43 trial, a randomized double-blind, placebo controlled trial of RAASI by valsartan, aliskiren, or both in post-ACS patients with preserved ventricular function but increased natriuretic peptides. Aldosterone was measured at randomization and week 8. RESULTS Median aldosterone concentrations were comparable across treatment arms at baseline (9.26 ng/dL; interquartile range 7.12–12.76; n = 1073). In the placebo group, there was a significant increase in aldosterone over 8 weeks (19.7% rise, 2.20 (0.36) ng/dL, P < 0.0001) that was significantly reduced across active RAASI therapies (1.36 (0.39) ng/dL with aliskiren; 1.02 (0.37) ng/dL with valsartan; and 0.85 (0.37) ng/dL with combination therapy, P trend = 0.008). Compared to placebo, RAASI monotherapy resulted in a pooled relative absolute aldosterone change of −1.01 (0.45) ng/dL (P = 0.026 vs placebo), and combination therapy resulted in a relative absolute aldosterone change of −1.35 (0.52) ng/dL (P = 0.01 vs placebo). No significant difference in aldosterone concentrations was achieved between dual vs single RAASI (P = 0.47). CONCLUSIONS In ACS patients with preserved ventricular function but increased natriuretic peptides, serum aldosterone rises over time and is blunted by more complete RAASI. The clinical implications and role for RAASI in this population warrant further investigation.

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Long-term results of different approaches to revascularization in non-ST-segment elevation acute coronary syndrome and multiple coronary atherosclerosis

Terapevticheskii arkhiv ◽

10.17116/terarkh201789429-34 ◽

2017 ◽

Vol 89 (4) ◽

pp. 29-34 ◽

Cited By ~ 1

Author(s):

V I Ganyukov ◽

R S Tarasov ◽

Yu N Neverova ◽

N A Kochergin ◽

O L Barbarash ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Coronary Artery ◽

Medical Treatment ◽

Coronary Atherosclerosis ◽

Long Term Results ◽

St Segment Elevation ◽

Coronary Syndrome ◽

St Segment

Aim. To assess the long-term results of different approaches to treating patients with non-ST-segment elevation acute coronary syndrome (NSTE ACS) and multivessel coronary artery disease (MVCAD). Subjects and methods. A total of 150 patients with NSTE ACS, in whom coronary angiography revealed MVCAD, were examined. The patients were divided into 3 groups according to the selected treatment policy: 1) percutaneous coronary intervention (PCI) (n=91 (60.6%)); 2) coronary artery bypass grafting (CABG) (n=40 (26.6%)); and 3) only medical treatment (n=9 (6%)). The mean follow-up was 27.6±3.5 months. Results. The medical treatment policy in this patient sample demonstrates the worst results, with the majority of cardiovascular events developing in the hospital period. PCI in patients with NSTE ACS and multiple coronary atherosclerosis has a number of objective limitations in this patient sample, leading to suboptimal treatment outcomes Conclusion. The use of CABG or PCI as a myocardial revascularization technique in patients with NSTE ACS and MVCAD is characterized by a comparable satisfactory survival in the hospital and long-term follow-up periods. 12% of patients do not receive revascularization due to the extremely high risk from any of coronary blood restoring methods, which results in very many deaths largely occurring during the hospital period.

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