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Eur Heart J. 2015 Feb 21;36(8):490-500. doi: 10.1093/eurheartj/ehu373. Epub 2014 Sep 2.

Effect of high-intensity statin therapy on atherosclerosis in non-infarct-related coronary arteries (IBIS-4): a serial intravascular ultrasonography study.

Author information

1
Department of Cardiology, Bern University Hospital, 3010, Bern, Switzerland.
2
Clinical Trials Unit, Bern University, Bern, Switzerland.
3
Cardiac Catheterization Laboratory, Rigshospitalet, Copenhagen, Denmark.
4
Division of Cardiology, University Hospital, Geneva, Switzerland.
5
Cardiocentro, Lugano, Switzerland.
6
Cardiology Department, University Hospital Zurich, Zurich, Switzerland.
7
Cardialysis BV, Rotterdam, The Netherlands.
8
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.

Abstract

AIM:

The effect of long-term high-intensity statin therapy on coronary atherosclerosis among patients with acute ST-segment elevation myocardial infarction (STEMI) is unknown. The aim of this study was to quantify the impact of high-intensity statin therapy on plaque burden, composition, and phenotype in non-infarct-related arteries of STEMI patients undergoing primary percutaneous coronary intervention (PCI).

METHODS AND RESULTS:

Between September 2009 and January 2011, 103 STEMI patients underwent intravascular ultrasonography (IVUS) and radiofrequency ultrasonography (RF-IVUS) of the two non-infarct-related epicardial coronary arteries (non-IRA) after successful primary PCI. Patients were treated with high-intensity rosuvastatin (40 mg/day) throughout 13 months and serial intracoronary imaging with the analysis of matched segments was available for 82 patients with 146 non-IRA. The primary IVUS end-point was the change in per cent atheroma volume (PAV). After 13 months, low-density lipoprotein cholesterol (LDL-C) had decreased from a median of 3.29 to 1.89 mmol/L (P < 0.001), and high-density lipoprotein cholesterol (HDL-C) levels had increased from 1.10 to 1.20 mmol/L (P < 0.001). PAV of the non-IRA decreased by -0.9% (95% CI: -1.56 to -0.25, P = 0.007). Patients with regression in at least one non-IRA were more common (74%) than those without (26%). Per cent necrotic core remained unchanged (-0.05%, 95% CI: -1.05 to 0.96%, P = 0.93) as did the number of RF-IVUS defined thin cap fibroatheromas (124 vs. 116, P = 0.15).

CONCLUSION:

High-intensity rosuvastatin therapy over 13 months is associated with regression of coronary atherosclerosis in non-infarct-related arteries without changes in RF-IVUS defined necrotic core or plaque phenotype among STEMI patients.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00962416.

KEYWORDS:

Atherosclerosis; Intravascular Ultrasound; Radiofrequency; ST-elevation myocardial infarction; Statin

PMID:
25182248
DOI:
10.1093/eurheartj/ehu373
[Indexed for MEDLINE]
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