Clinical Predictors for Lack of Favorable Vascular Response to Statin Therapy in Patients With Coronary Artery Disease: A Serial Optical Coherence Tomography Study

Abstract

BackgroundPrevious studies have demonstrated that statin therapy improves cardiac outcomes, probably by stabilizing thin‐cap fibroatheroma in patients with coronary artery disease. However, major adverse cardiac events still occur in some patients, despite statin therapy. The aim of this study is to identify clinical predictors for the lack of a favorable vascular response to statin therapy in patients with coronary artery disease.Methods and ResultsA total of 140 nonculprit plaques from 84 patients with coronary artery disease who were treated with a statin and had serial optical coherence tomography imaging (median interval, 6.3 months) were included. Thin‐cap area (fibrous cap thickness, <200 μm) was measured using a novel 3‐dimensional computer‐aided algorithm. Overall, the thin‐cap area significantly decreased from baseline (median, 2.852 mm2; 25th–75th percentile, 1.023–6.157 mm2) to follow‐up (median, 1.210 mm2; 25th–75th percentile, 0.250–3.192 mm2; P<0.001), and low‐density lipoprotein cholesterol significantly decreased from baseline (mean±SD, 92.9±30.1 mg/dL) to follow‐up (mean±SD, 76.3±23.3 mg/dL; P<0.001). The general linear model with multiple predictor variables revealed that the thin‐cap area was significantly higher in patients with chronic kidney disease than in those without it (regression coefficient b, 1.691 mm2; 95% confidence interval, 0.350–3.033 mm2; P=0.013) and lower in patients with acute coronary syndrome (regression coefficient b, −1.535 mm2; 95% confidence interval, −2.561 to −0.509 mm2; P=0.003).ConclusionsChronic kidney disease is an independent predictor for the lack of a favorable vascular response to statin therapy, whereas acute coronary syndrome is an independent predictor for favorable vascular response to statin therapy. These findings should be further warranted in future prospective studies.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT01110538.

Impaired Flow-Mediated Dilation and Severity and Vulnerability of Culprit Plaque in Patients with Coronary Artery Disease

“…8) Second, multiple antiinflammatory drugs, including statins, had already been prescribed for most patients in the present cohort. Because those drugs could immediately stabilize the vulnerable coronary plaque, 21,22) the possible association between FMD and plaque vulnerability might have been confounded in the present study in contrast to a previous study showing a sharp relationship between these factors. Clinical implication: Ultrasound assessment of FMD in the brachial arteries is a sensitive and noninvasive method of evaluating endothelium-dependent vasomotion, which reflects systemic endothelial function.…”

Lipoprotein (a) level is associated with plaque vulnerability in patients with coronary artery disease: An optical coherence tomography study

“…In the present study, higher LDL-C values were not independently associated with higher prevalence of OCT-TCFA. This might be due to the high percentage of statin prescription in the present cohort, which could influence both LDL-C values and plaque morphologies and blur the correlation between them [17]. In contrast, Lp(a) is known not to be largely influenced by pharmacological intervention other than the prescription of proprotein convertase subtilisin/kexin type 9 inhibitor (iPCSK9) [4].…”

“…The best cut-off value of Lp(a) was identified by maximizing the sum of sensitivity and specificity. Multivariate logistic regression analysis was performed to determine the independent factors for the presence of OCT-TCFA, including factors that suggested an association with the presence of TCFA [16,17]. Statistical significance was defined as p < 0.05.…”

Three-Dimensional Fibrous Cap Structure of Coronary Lipid Plaque ― ST-Elevation Myocardial Infarction vs. Stable Angina ―

“…16 First, FCT may undergo dynamic changes over time due to physical or biological factors. [17][18][19] Second, FC is a 3-D structure, and measuring FCT at a single point may not be representative of its complexity. The generalization may introduce bias on how TCFA is diagnosed and how results of studies are interpreted.…”