Li Zhennan, Hou Zhihui, Yin Weihua, Liu Kun, Gao Yang, Xu Haiyan, Yu Fangfang, Ma Zhanhong, Yu Wei, Yang Li, Lu Bin
Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
Department of Cardiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
Am Heart J. 2016 Oct;180:29-38. doi: 10.1016/j.ahj.2016.06.023. Epub 2016 Jul 14.
There are limited data assessing statin therapy in patients with nonobstructive coronary plaque on coronary computed tomography angiography (CCTA).
Two hundred six consecutive patients with mild noncalcified plaque on CCTA were enrolled in this multicenter prospective observational study. Subjects were divided into 3 groups according to subsequent statin therapy: intensive statin therapy (n = 55), moderate statins (n = 85), and no statin (n = 66). Serial scans were performed after a median interval of 18 months. Low-attenuation plaque (LAP) volume, total plaque volume, and percent plaque volume were measured.
The LAP volume, total plaque volume, and percent plaque volume showed significant regression among intensive-statin compared with no-statin group (annualized changes: -7.1 ± 13.1 vs 0.9 ± 12.7 mm(3), P< .001; -16.4 ± 35.0 vs 12.3 ± 32.4 mm(3), P< .001; and -6.2% ± 11.8% vs 3.5% ± 12.1%, P< .001, respectively). Progression of LAP volume, total plaque volume, and percent plaque volume was retarded among moderate-statin compared with no-statin group (annualized changes: -2.8 ± 7.6 vs 0.9 ± 12.7 mm(3), P= .041; -0.1 ± 25.6 vs 12.3 ± 32.4 mm(3), P= .014; and -1.8% ± 11.2% vs 3.5% ± 12.1%, P= .006, respectively). On multivariable model predicting change in total plaque volume, higher baseline LAP volume, moderate statin therapy, and intensive statin therapy were each independent predictors of plaque regression (standardized coefficients: baseline LAP volume -0.36, P< .001; moderate statin -0.21, P= .004; intensive statin -0.36, P< .001, respectively).
This study suggests that statin treatment can retard progression and even induce regression of mild noncalcified coronary plaque. Patients with greater baseline LAP volume are more likely to benefit from statin therapy.
关于在冠状动脉计算机断层扫描血管造影（CCTA）中对非阻塞性冠状动脉斑块患者进行他汀类药物治疗的数据有限。
连续纳入206例在CCTA上有轻度非钙化斑块的患者进行这项多中心前瞻性观察研究。根据后续他汀类药物治疗将受试者分为3组：强化他汀治疗组（n = 55）、中度他汀治疗组（n = 85）和未使用他汀组（n = 66）。在中位间隔18个月后进行系列扫描。测量低衰减斑块（LAP）体积、总斑块体积和斑块体积百分比。
与未使用他汀组相比，强化他汀治疗组的LAP体积、总斑块体积和斑块体积百分比有显著消退（年化变化：-7.1±13.1 vs 0.9±12.7 mm³，P <.001；-16.4±35.0 vs 12.3±32.4 mm³，P <.001；以及-6.2%±11.8% vs 3.5%±12.1%，P <.001）。与未使用他汀组相比，中度他汀治疗组的LAP体积、总斑块体积和斑块体积百分比的进展有所延缓（年化变化：-2.8±7.6 vs 0.9±12.7 mm³，P =.041；-0.1±25.6 vs 12.3±32.4 mm³，P =.014；以及-1.8%±11.2% vs 3.5%±12.1%，P =.006）。在预测总斑块体积变化的多变量模型中，较高的基线LAP体积、中度他汀治疗和强化他汀治疗均是斑块消退的独立预测因素（标准化系数：基线LAP体积-0.36，P <.001；中度他汀-0.21，P =.004；强化他汀-0.36，P <.001）。
本研究表明他汀类药物治疗可延缓轻度非钙化冠状动脉斑块的进展，甚至促使其消退。基线LAP体积较大的患者更可能从他汀类药物治疗中获益。
