Abstract 11734: Allopurinol & Plaque Stabilization in Patients With Acute Coronary Syndrome: A Randomized Clinical Trial

Abstract

Background: Allopurinol, a xanthine inhibitor that lowers uric acid (UA) concentration, has been proven to reduce inflammation and oxidative stress in patients with cardiovascular disease. However, it is unknown whether these beneficial effects translate into favorable plaque modification in acute coronary syndromes (ACS). Aims: This study aimed to investigate whether allopurinol therapy could improve plaque stabilization in ACS patients using coronary computed tomography angiography (CCTA). Methods: This was a prospective, single-center, randomized, double-blind clinical trial began in March 2019 (clinical trial.gov identifier NCT03745729). A total of 162 acute coronary syndromes (ACS) patients aged 18-80 years with a blood level of high-sensitivity C-reactive protein (hsCRP) > 2 mg/L were included. The subjects were randomly assigned in a 1:1 ratio to receive either allopurinol sustained-release capsules (at a dose of 0.25 g once daily) or placebo for 12 months. The primary efficacy endpoint was the change in low-attenuation plaque volume (LAPV) from baseline to the 12-month follow-up. Results: Among 162 patients, 54 in allopurinol group and 51 in placebo group completed the study. There were no significant differences between the allopurinol and placebo groups in terms of baseline data for age (58.5±10.2 years vs. 56.8±10.0 years, P=0.392) and sex (male/female, 40/14 vs. 40/11, P=0.600). The median follow-up duration was 14 months in both groups. Compared with placebo, allopurinol therapy did not significantly alter LAPV (-13.4±3.7% vs. -17.8±3.6%, P=0.390), intermediate attenuation plaque volume (-16.1±3.0% vs. -16.2±2.9%, P=0.992), dense calcified plaque volume (12.2±13.7% vs. 9.7±13.0%, P=0.894), total atheroma volume (-15.2±3.2% vs. -16.4±3.1%, P=0.785), remodeling index (2.0±3.9% vs. 5.4±3.8%, P=0.536) or hsCRP levels (-73.6 [17.9-91.6] % vs. -81.2 [47.7-95.4] %, P=0.286). Conclusions: Our findings suggest, for the first time, that allopurinol therapy does not improve atherosclerotic plaque instability or inflammation in ACS.