Clinical significance of non-culprit plaque regression following acute coronary syndrome: A serial intravascular ultrasound study

被引:9
作者
Endo, Hirohisa [1 ]
Dohi, Tomotaka [1 ]
Miyauchi, Katsumi [1 ]
Kuramitsu, Shoichi [2 ]
Kato, Yoshiteru [1 ]
Okai, Iwao [1 ]
Yokoyama, Miho [1 ]
Yokoyama, Takayuki [1 ]
Ando, Kenji [2 ]
Okazaki, Shinya [1 ]
Shimada, Kazunori [1 ]
Suwa, Satoru [3 ]
Daida, Hiroyuki [1 ]
机构
[1] Juntendo Univ, Dept Cardiovasc Med, Grad Sch Med, Tokyo, Japan
[2] Kokura Mem Hosp, Dept Cardiol, Kitakyushu, Japan
[3] Juntendo Univ, Shizuoka Hosp, Dept Cardiovasc Med, Shizuoka, Japan
基金
日本学术振兴会;
关键词
Plaque regression; Serial intravascular ultrasound; Low-density lipoprotein cholesterol; Acute coronary syndrome; DENSITY-LIPOPROTEIN CHOLESTEROL; LONG-TERM OUTCOMES; VERY-LOW LEVELS; CARDIOVASCULAR EVENTS; STATIN THERAPY; HEART-DISEASE; EZETIMIBE; RISK; TRIGLYCERIDES; PROGRESSION;
D O I
10.1016/j.jjcc.2018.12.023
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: The use of serial intravascular ultrasound (IVUS) for coronary atherosclerosis has offered valuable insight into plaque regression (PR) or progression. However, the beneficial effects of PR on the long-term clinical outcomes in patients with acute coronary syndrome (ACS) remain unclear. We aimed to evaluate the impact of coronary plaque change in patients following primary percutaneous coronary intervention. Methods: We retrospectively analyzed data from 4 prospective clinical trials involving 173 patients with ACS who underwent serial IVUS of non-culprit lesions on statin treatment at baseline and at 6 or 8 months of follow-up. The relationship of the IVUS findings with the change in percent atheroma volume (PAV), on-treatment low-density lipoprotein cholesterol (LDL-C), and major adverse cardiac and cerebrovascular events (MACCE) were investigated. Results: In our serial IVUS analysis, baseline plaque volume and PAV were 79.6 mm(3) and 46.0%, respectively. The overall change in PAV was -1.5% [interquartile range (IQR): -4.1% to 1.0%), and PR (i.e. PAV change from baseline <0) was observed in 67.1% of patients. They were followed up observationally for a mean of 3.5 years and a total of 37 MACCE occurred. The rate of MACCE tended to be lower in patients with PR than in those without PR (18.1% vs. 28.7%, p = 0.14). A multivariate Cox hazard model analysis demonstrated that achievement of both PR and on-treatment low LDL-C levels (<70 mg/dL) was the only significant independent predictor of MACCE (hazard ratio: 0.42, 95% confidence interval: 0.19-0.88: p = 0.02). Conclusions: Achievement of both PR and sufficient lowering of the LDL-C was clinically important in post-ACS management. (C) 2019 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
引用
收藏
页码:102 / 108
页数:7
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