Clinically evident polyvascular disease and regression of coronary atherosclerosis after intensive statin therapy in patients with acute coronary syndrome: serial intravascular ultrasound from the Japanese assessment of pitavastatin and atorvastatin in acute coronary syndrome (JAPAN-ACS) trial |
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| Authors: | Hibi Kiyoshi Kimura Takeshi Kimura Kazuo Morimoto Takeshi Hiro Takafumi Miyauchi Katsumi Nakagawa Yoshihisa Yamagishi Masakazu Ozaki Yukio Saito Satoshi Yamaguchi Tetsu Daida Hiroyuki Matsuzaki Masunori;JAPAN-ACS Investigators |
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| Institution: | aDivision of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan;bDepartment of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan;cCenter for Medical Education, Kyoto University Graduate School of Medicine, Kyoto, Japan;dDivision of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan;eDepartment of Cardiology, Juntendo University School of Medicine, Tokyo, Japan;fDepartment of Cardiology, Tenri Hospital, Nara, Japan;gDivision of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan;hDepartment of Cardiology, Fujita Health University, Toyoake, Japan;iKeiai Hospital, Tokyo, Japan;jToranomon Hospital, Tokyo, Japan;kDivision of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan |
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| Abstract: | AimTo clarify whether the effects of statin treatment on plaque regression vary according to the presence or absence of polyvascular disease (PVD) in patients with acute coronary syndrome (ACS).Methods307 patients with ACS who underwent percutaneous coronary intervention for the culprit lesion at 33 centers were treated with atorvastatin or pitavastatin. Noncoronary atherosclerosis was defined as coexistent, clinically recognized arterial disease other than coronary artery disease (CAD) (cerebral, aortic, or lower extremity). Intravascular ultrasound (IVUS) was performed to assess non-culprit coronary atherosclerosis at baseline and at 8–12 months follow-up. Serial IVUS examinations were obtained in 252 patients. Atheroma volume and percent change in atheroma volume of the target plaque was assessed.ResultsPatients of the CAD + PVD (n = 19) were older (68 vs. 62 years, p = 0.02), had lower low-density lipoprotein cholesterol (LDL-C) levels at baseline (116 vs. 134 mg/dL, p = 0.03) than those of the CAD-only group (n = 233), whereas LDL-C levels at follow-up were similar (81 vs. 83 mg/dL). Although the baseline plaque volume was similar in the two groups (59 vs. 57 mm3), patients of the CAD + PVD group showed milder regression of atherosclerosis than those of the CAD-only group (−8.9% vs. −18.2%, p = 0.005). This difference remained significant even after adjustment for coronary risk factors including age and serum LDL-C (p = 0.047).ConclusionsStatin treatment results in milder regression of coronary atherosclerosis in CAD patients with polyvascular disease compared to those with CAD only. |
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| Keywords: | Abbreviations: ABPI ankle&ndash brachial pressure index ACS acute coronary syndrome CAD coronary artery disease CSA cross-sectional area EEM external elastic membrane HDL-C high density lipoprotein cholesterol IVUS intravascular ultrasound LDL-C low density lipoprotein cholesterol PCI percutaneous coronary intervention PV plaque volume PVD polyvascular disease |
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