Abstract
BackgroundStatin therapy results in regression and stabilization of coronary artery plaques, and reduces the incidence of coronary artery disease. However, statin therapy does not effectively halt the accumulation of necrotic core in all patients. The purpose of the present study was to identify the predictors associated with necrotic core progression during statin therapy.MethodsCoronary atherosclerosis in non-culprit lesions was evaluated using virtual histology intravascular ultrasound at baseline and 8 months after statin therapy. One hundred nineteen patients were divided into 2 groups based on necrotic core progression or regression during an 8-month follow-up period.ResultsPatients with necrotic core progression had higher serum lipoprotein(a) [Lp(a)] levels than patients with regression at baseline (16 mg/dL vs. 12 mg/dL, p = 0.02) and at the 8-month follow-up (17 mg/dL vs. 10 mg/dL, p = 0.006). Patients with necrotic core progression had a higher fibro-fatty plaque volume (1.28 mm3/mm vs. 0.73 mm3/mm, p = 0.002), and less necrotic core (0.56 mm3/mm vs. 1.04 mm3/mm, p < 0.0001) and dense calcium (0.35 mm3/mm vs. 0.56 mm3/mm, p = 0.006) plaque volumes at baseline than patients with regression. Multivariate logistic regression analysis showed that Lp(a) was a significant independent predictor associated with necrotic core progression during statin therapy (odds ratio [OR]: 3.514; 95% confidence interval [CI]: 1.338-9.228; p = 0.01).ConclusionsSerum Lp(a) is independently associated with necrotic core progression in statin-treated patients with angina pectoris.
Highlights
Statin therapy results in regression and stabilization of coronary artery plaques, and reduces the incidence of coronary artery disease
In the present study, we compared clinical characteristics, serum lipid profiles, and grayscale and Virtual histology (VH)-intravascular ultrasound (IVUS) parameters between patients with necrotic core progression and those with regression to identify predictors associated with necrotic core progression during statin therapy
164 patients with angina pectoris were randomized to either pitavastatin (4 mg/day, intensive lipid-lowering) or pravastatin (20 mg/day, moderate lipid-lowering) therapy after successful percutaneous coronary intervention (PCI) performed under VH-IVUS guidance
Summary
Statin therapy results in regression and stabilization of coronary artery plaques, and reduces the incidence of coronary artery disease. Statin therapy does not effectively halt the accumulation of necrotic core in all patients. The purpose of the present study was to identify the predictors associated with necrotic core progression during statin therapy. The mechanisms by which statins provide cardiovascular benefits are not clearly understood, regression and stabilization of coronary artery plaques are presumed to play important roles in this effect [2,3]. Virtual histology (VH)-intravascular ultrasound (IVUS) uses spectral analysis of radiofrequency ultrasound backscatter signals, which allows the identification of 4 different types of atherosclerotic necrotic core progression and those with regression to identify predictors associated with necrotic core progression during statin therapy
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