Lee Cheol Hyun, Hwang Jongmin, Kim In-Cheol, Cho Yun-Kyeong, Park Hyoung-Seob, Yoon Hyuck-Jun, Kim Hyungseop, Han Seongwook, Hur Seung-Ho, Kim Kwon-Bae, Kim Jin Young, Chung Jin-Wook, Lee Joo Myung, Doh Joon-Hyung, Shin Eun-Seok, Koo Bon-Kwon, Nam Chang-Wook
Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea.
Department of Radiology, Keimyung University Dongsan Hospital, Daegu, Republic of Korea.
JACC Asia. 2022 Nov 1;2(6):691-703. doi: 10.1016/j.jacasi.2022.07.010. eCollection 2022 Nov.
The effects of statin on coronary physiology have not been well evaluated.
The authors performed this prospective study to investigate changes in coronary flow indexes and plaque parameters, and their associations with atorvastatin therapy in patients with coronary artery disease (CAD).
Ninety-five patients with intermediate CAD who received atorvastatin therapy underwent comprehensive physiological assessments with fractional flow reserve (FFR), coronary flow reserve, index of microcirculatory resistance, and intravascular ultrasound at the index procedure, and underwent the same evaluations at 12-month follow-up. Optimal low-density lipoprotein cholesterol (LDL-C) was defined as LDL-C <70 mg/dL or ≥50% reduction from the baseline. The primary endpoint was a change in the FFR.
Baseline FFR, minimal lumen area, and percent atheroma volume (PAV) were 0.88 ± 0.05, 3.87 ± 1.28, 55.92 ± 7.30, respectively. During 12 months, the percent change in LDL-C was -33.2%, whereas FFR was unchanged (0.87 ± 0.06 at 12 months; = 0.694). Vessel area, lumen area, and PAV were significantly decreased (all values <0.05). The achieved LDL-C level and the change of PAV showed significant inverse correlations with the change in FFR. In patients with optimally modified LDL-C, the FFR had increased (0.87 ± 0.06 vs 0.89 ± 0.07; = 0.014) and the PAV decreased (56.81 ± 6.44% vs 55.18 ± 8.19%; = 0.031), whereas in all other patients, the FFR had decreased (0.88 ± 0.05 vs 0.86 ± 0.06; = 0.025) and the PAV remained unchanged.
In patients with CAD, atorvastatin did not change FFR despite a decrease in the PAV. However, in patients who achieved the optimal LDL-C target level with atorvastatin, the FFR had significantly increased with decrease of the PAV. (Effect of Atorvastatin on Fractional Flow Reserve in Coronary Artery Disease [FORTE]; NCT01946815).
他汀类药物对冠状动脉生理功能的影响尚未得到充分评估。
作者进行了这项前瞻性研究，以调查冠状动脉血流指数和斑块参数的变化，以及它们与冠状动脉疾病（CAD）患者阿托伐他汀治疗的相关性。
95例接受阿托伐他汀治疗的中度CAD患者在首次手术时接受了包括血流储备分数（FFR）、冠状动脉血流储备、微循环阻力指数和血管内超声在内的全面生理评估，并在12个月随访时进行了相同的评估。最佳低密度脂蛋白胆固醇（LDL-C）定义为LDL-C<70mg/dL或较基线降低≥50%。主要终点是FFR的变化。
基线时FFR、最小管腔面积和粥样斑块体积百分比（PAV）分别为0.88±0.05、3.87±1.28、55.92±7.30。在12个月期间，LDL-C的百分比变化为-33.2%，而FFR未改变（12个月时为0.87±0.06；P=0.694）。血管面积、管腔面积和PAV显著降低（所有P值<0.05）。达到的LDL-C水平和PAV的变化与FFR的变化呈显著负相关。在LDL-C得到最佳改善的患者中，FFR升高（0.87±0.06对0.89±0.07；P=0.014），PAV降低（56.81±6.44%对55.18±8.19%；P=0.031），而在所有其他患者中，FFR降低（0.88±0.05对0.86±0.06；P=0.025），PAV保持不变。
在CAD患者中，阿托伐他汀虽使PAV降低，但未改变FFR。然而，在通过阿托伐他汀达到最佳LDL-C目标水平的患者中，FFR随PAV的降低而显著升高。（阿托伐他汀对冠状动脉疾病患者血流储备分数的影响[FORTE]；NCT01946815）
