Ota Hideaki, Omori Hiroyuki, Kawasaki Masanori, Hirakawa Akihiro, Matsuo Hitoshi
Department of Cardiology, Gifu Heart Center, 4-14-4 Yabuta-minami, Gifu 500-8384, Japan.
Division of Biostatistics and Data Science, Clinical Research Center, Tokyo Medical and Dental University, Tokyo, Japan.
Eur Heart J Cardiovasc Imaging. 2022 Jan 24;23(2):217-228. doi: 10.1093/ehjci/jeab034.
This study aimed to determine the effects of a proprotein convertase subtilisin-kexin type 9 inhibitor (PCSK9i) on coronary plaque volume and lipid components in patients with a history of coronary artery disease (CAD).
This prospective, open-label, single-centre study analysed non-culprit coronary segments using near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS) at baseline and follow-up angiography. Following changes in the lipid-lowering treatment based on the most recent guideline, the enrolled subjects were divided into two groups: treatment with PCSK9i and statins (PCSK9i: 21 patients and 40 segments) and statins only (control: 32 patients and 50 segments). The absolute and percent LDL-C reductions were significantly greater in the PCSK9i group than in the control group (between group difference: 59.3 mg/dL and 46.4%; P < 0.001 for both). The percent reduction in normalized atheroma volume and absolute reduction in percent atheroma volume (PAV) were also significantly greater in the PCSK9i group (P < 0.001 for both). Furthermore, the PCSK9i group showed greater regression of maximal lipid core burden index for each of the 4-mm segments (maxLCBI4mm) than the control group (57.0 vs. 25.5; P = 0.010). A significant linear correlation was found between the percent changes in LDL-C and maxLCBI4mm (r = 0.318; P = 0.002), alongside the reduction in PAV (r = 0.386; P < 0.001).
The lipid component of non-culprit coronary plaques was significantly decreased by PCSK9i. The effects of statin combined with PCSK9i might be attributed to the stabilization and regression of residual vulnerable coronary plaques in patients with CAD.
本研究旨在确定前蛋白转化酶枯草溶菌素9型抑制剂（PCSK9i）对有冠状动脉疾病（CAD）病史患者冠状动脉斑块体积和脂质成分的影响。
这项前瞻性、开放标签、单中心研究在基线和随访血管造影时使用近红外光谱-血管内超声（NIRS-IVUS）分析非罪犯冠状动脉节段。根据最新指南改变降脂治疗方案后，将入选受试者分为两组：PCSK9i与他汀类药物联合治疗组（PCSK9i组：21例患者和40个节段）和仅使用他汀类药物组（对照组：32例患者和50个节段）。PCSK9i组的低密度脂蛋白胆固醇（LDL-C）绝对降低值和降低百分比均显著高于对照组（组间差异：59.3mg/dL和46.4%；两者P均<0.001）。PCSK9i组的标准化动脉粥样硬化体积降低百分比和动脉粥样硬化体积百分比（PAV）绝对降低值也显著更高（两者P均<0.001）。此外，PCSK9i组每个4毫米节段的最大脂质核心负担指数（maxLCBI4mm）的消退程度均大于对照组（57.0对25.5；P = 0.010）。LDL-C百分比变化与maxLCBI4mm之间存在显著线性相关性（r = 0.318；P = 0.002），同时与PAV降低也存在相关性（r = 0.386；P < 0.001）。
PCSK9i可使非罪犯冠状动脉斑块的脂质成分显著降低。他汀类药物联合PCSK9i的作用可能归因于CAD患者残余易损冠状动脉斑块的稳定和消退。
