Yonsei Med J.  2013 Mar;54(2):336-344. 10.3349/ymj.2013.54.2.336.

Early Differential Changes in Coronary Plaque Composition According to Plaque Stability Following Statin Initiation in Acute Coronary Syndrome: Classification and Analysis by Intravascular Ultrasound-Virtual Histology

• Hwang DS
• Shin ES
• Kim SJ
• Lee JH
• Kim JM
• Lee SG

• KMID: 1503894
• DOI: http://doi.org/10.3349/ymj.2013.54.2.336

Abstract

PURPOSE
The aim of this study was to demonstrate the early effects of statin treatment on plaque composition according to plaque stability on Intravascular Ultrasound-Virtual Histology at 6 months after a coronary event. Previous trials have demonstrated that lipid lowering therapy with statins decreases plaque volume and increases plaque echogenicity in patients with coronary artery disease.
MATERIALS AND METHODS
Fifty-four patients (54 lesions) with acute coronary syndrome were prospectively enrolled. We classified and analyzed the target plaques into two types according to plaque stability: thin-cap fibroatheroma (TCFA, n=14) and non-TCFA (n=40). The primary end point was change in percent necrotic core in the 10-mm subsegment with the most disease.
RESULTS
After 6 months of statin therapy, no change was demonstrated in the mean percentage of necrotic core (18.7+/-8.5% to 20.0+/-11.0%, p=0.38). There was a significant reduction in necrotic core percentage in patients with TCFA (21.3+/-7.2% to 14.4+/-8.9%, p=0.017), but not in patients with non-TCFA. Moreover, change in percent necrotic core was significantly correlated with change in high-sensitivity C-reactive protein levels (r=0.4, p=0.003). Changes in low-density lipoprotein cholesterol levels and lipid core percentage demonstrated no significant associations.
CONCLUSION
A clear reduction of lipid core was observed only for the TCFA plaque type, suggesting that changes in plaque composition following statin therapy might occur earlier in vulnerable plaque than in stable plaque; the effect may be related to the anti-inflammatory effects of statins.

Keyword

Acute coronary syndromes; statin; IVUS-VH

MeSH Terms

Acute Coronary Syndrome/*drug therapy/ultrasonography
Aged
C-Reactive Protein/metabolism
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic use
Male
Middle Aged
Plaque, Atherosclerotic/*ultrasonography
Ultrasonography, Interventional
Hydroxymethylglutaryl-CoA Reductase Inhibitors
C-Reactive Protein

Figure

• 

  Fig. 1 (A) Change in mean percent necrotic core in the most diseased 10-mm subsegment during 6-month follow-up. Significant reduction in percent necrotic core in TCFA is observed. (B) Change in mean absolute necrotic core volume in the most diseased 10-mm subsegment during 6-month follow-up. Significant reduction in absolute necrotic core volume in TCFA is observed. TCFA, thin-cap fibroatheroma; NS, non-specific.

• 

  Fig. 2 Change in percentages of the four plaque components in TCFA (n=14) during 6-month follow-up. TCFA, thin-cap fibroatheroma.

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  Fig. 3 Representative examples of IVUS-VH images at largest necrotic core site for each plaque type. Baseline (left panel) and follow-up (right panel) images are displayed side by side. (A) Baseline image in the TCFA type. (B) Reduction of necrotic core is clearly observed after 6 months. (C) Baseline image in the non-TCFA type. (D) Increase of necrotic core is clearly observed. IVUS-VH, Intravascular Ultrasound-Virtual Histology; TCFA, thin-cap fibroatheroma.

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  Fig. 4 Correlation between (A) change in necrotic core percentage and change in LDL-C level, as well as between (B) change in necrotic core percentage and change in CRP level. LDL-C, low-density lipoprotein cholesterol; CRP, C-reactive protein.

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