Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
J Cardiol. 2019 Aug;74(2):102-108. doi: 10.1016/j.jjcc.2018.12.023. Epub 2019 Feb 5.
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.
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.
In our serial IVUS analysis, baseline plaque volume and PAV were 79.6mm 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 (<70mg/dL) was the only significant independent predictor of MACCE (hazard ratio: 0.42, 95% confidence interval: 0.19-0.88; p=0.02).
Achievement of both PR and sufficient lowering of the LDL-C was clinically important in post-ACS management.
连续血管内超声（IVUS）在冠状动脉粥样硬化中的应用为斑块消退（PR）或进展提供了有价值的见解。然而，PR 对急性冠状动脉综合征（ACS）患者长期临床结局的有益影响尚不清楚。我们旨在评估经皮冠状动脉介入治疗后患者冠状动脉斑块变化的影响。
我们回顾性分析了 4 项前瞻性临床试验的数据，这些试验涉及 173 例接受他汀类药物治疗的 ACS 患者，这些患者在基线和 6 或 8 个月随访时接受了非罪犯病变的连续 IVUS。研究了 IVUS 结果与动脉粥样斑块体积百分比变化（PAV）、治疗中低密度脂蛋白胆固醇（LDL-C）和主要不良心脏和脑血管事件（MACCE）之间的关系。
在我们的连续 IVUS 分析中，基线斑块体积和 PAV 分别为 79.6mm 和 46.0%。PAV 的总体变化为-1.5%[四分位距（IQR）：-4.1%至 1.0%]，67.1%的患者观察到 PR（即 PAV 变化较基线<0）。患者平均随访 3.5 年，共发生 37 例 MACCE。PR 患者的 MACCE 发生率低于无 PR 患者（18.1%比 28.7%，p=0.14）。多变量 Cox 风险模型分析表明，PR 和治疗中 LDL-C 水平（<70mg/dL）的达标是 MACCE 的唯一显著独立预测因素（风险比：0.42，95%置信区间：0.19-0.88；p=0.02）。
在 ACS 后管理中，实现 PR 和充分降低 LDL-C 具有重要的临床意义。
