Plaque Regression Determined by Intravascular Ultrasound Predicts Long-Term Outcomes of Patients with Acute Coronary Syndrome

Abstract

Aim:The usefulness of drugs to treat plaque regression is assessed by intravascular ultrasound (IVUS); however, the impact of plaque regression on clinical outcomes in patients with acute coronary syndrome (ACS) has not been established; therefore, we investigated the relationship between coronary plaque regression and long-term clinical outcomes. Methods: We analyzed data from 86 patients who underwent percutaneous coronary intervention (PCI) and who were assessed in detail at baseline and at 6 months of follow-up by measuring proximal non-culprit sites of PCI lesions using volumetric IVUS. Patients were divided according to changes in plaque volume over 6 months into one group with plaque regression (n 55; 64.0%) and another with progression (n 31; 36.0%). They were followed up observationally for a mean of 1,736 days. Results: Baseline characteristics at the time of ACS were similar between the groups. The probability of event-free survival was significantly higher in the regression group than in the progression group as estimated by the Kaplan-Meier method (Log-rank test, p 0.032). Furthermore, the Cox hazards model revealed the relative contribution of plaque regression as a predictor of cardiovascular events (hazard ratio: 0.26; 95% CI, 0.07 to 0.83; p 0.023). Conclusions: Plaque regression determined by volumetric IVUS over a period of 6 months was associated with a lower rate of cardiovascular events among patients with ACS. This study also demonstrated that plaque regression could be a surrogate marker of future cardiovascular events. J Atheroscler Thromb, 2011; 18:231-239.

A review of statin use in patients with acute coronary syndrome in Western and Japanese populations

“…Event-free survival was significantly more likely in the plaque regression group than in the progression group, and plaque regression after 6 months was a predictor of CV events (HR 0.26, 95% CI 0.07, 0.83). 42 Given the association between LDL-C and progression/regression of atheroma, these data support the concept that achieving lower levels of LDL-C is as relevant to Japanese populations as it is to Western populations. 43 …”

“…41 A further analysis of the Extended-ESTABLISH trial investigated the prognostic value of plaque regression (observed after 6 months) on clinical outcome. 42 Patients were stratified into plaque regression (n ¼ 55) and plaque progression (n ¼ 31) groups, according to changes in plaque volume. Event-free survival was significantly more likely in the plaque regression group than in the progression group, and plaque regression after 6 months was a predictor of CV events (HR 0.26, 95% CI 0.07, 0.83).…”

Reverse Vessel Remodeling But Not Coronary Plaque Regression Could Predict Future Cardiovascular Events in ACS Patients With Intensive Statin Therapy

“…Previous IVUS studies have shown that the burden of coronary atherosclerosis and its progression is associated with an increased risk of adverse cardiovascular events in patients with stable coronary artery disease (CAD). 5 In the arena of acute coronary syndrome (ACS), the ESTABLISH study 6 and its extension study 7 revealed that intensive lipid-lowering therapy with statins resulted in coronary plaque regression, which was associated with a lower incidence of cardiovascular events. Therefore, it may be extrapolated that plaque regression measured by volumetric IVUS should be associated with a reduced cardiovascular event risk.…”

Impact of Total Risk Management on Coronary Plaque Regression in Diabetic Patients with Acute Coronary Syndrome

“…Furthermore, the intensive intervention to multiple risk factors also reduced the future risk of cardiovascular events during the mean follow-up period of 7.8 years compared with conventional therapy. Although our study differs from the STENO trial in terms of the study design, therapeutic intervention, and target goal for each risk factor, our result has its novelty in that we demonstrated the relationship in a dose-dependent manner between the number of risk factors (LDL-C, HbA1c, and BP) that achieved the target level and reduction in coronary artery plaque volume, which is an established surrogate marker of future cardiovascular events 25,26) . Our previous study showed that plaque regression assessed by volumetric IVUS was associated with a low incidence of cardiovascular events among patients with ACS 25) .…”

“…Although our study differs from the STENO trial in terms of the study design, therapeutic intervention, and target goal for each risk factor, our result has its novelty in that we demonstrated the relationship in a dose-dependent manner between the number of risk factors (LDL-C, HbA1c, and BP) that achieved the target level and reduction in coronary artery plaque volume, which is an established surrogate marker of future cardiovascular events 25,26) . Our previous study showed that plaque regression assessed by volumetric IVUS was associated with a low incidence of cardiovascular events among patients with ACS 25) . Nichols et al also proved the relationship between the burden of coronary atherosclerosis and adverse cardiovascular events in eight clinical trials that used serial IVUS 26) .…”