Abstract
Using serial intravascular ultrasound (IVUS), we evaluated the natural evolution of
non-culprit/non-target lesion ruptured coronary plaques and assessed the impact of
statin therapy. Twenty-eight patients with non-stenotic ruptured plaques underwent
baseline and 12-month follow-up IVUS studies; half were treated with statins. Standard
IVUS analyses were performed. Complete healing of ruptured plaques was observed in
four (29%) statin-treated patients and no non-statin-treated patients (p = 0.049). Statin-treated patients had an increase in lumen area of 0.4 ± 0.8 mm2 (versus a decrease in lumen area of −0.6 ± 1.0 mm2 in non-statin-treated patients, p = 0.007) and no change in plaque area (versus an increase in plaque area of 0.6 ± 0.9 mm2, p = 0.051). During 1-year follow-up, target lesion revascularization was performed in
three non-statin-treated patients (21%) and no statin-treated patient (p = 0.11). Compared to lesions that did not require revascularization, lesions requiring
revascularization had a decrease in lumen area (−1.7 ± 1.4 mm2 versus 0.1 ± 0.8 mm2, p = 0.001) as well as an increase in plaque area (1.6 ± 1.0 mm2 versus 0.1 ± 0.7 mm2, p = 0.002). In conclusion, the current observational follow-up IVUS study showed beneficial
effects of statin treatment on reduction of revascularization rates and stabilization
of non-culprit/non-target lesion plaque ruptures without significant stenosis. Conversely,
healing of non-statin-treated non-culprit/non-target lesion plaque ruptures can be
responsible for lesion progression requiring revascularization.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to AtherosclerosisAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions.Arterioscler Thromb Vasc Biol. 2000; 20: 1262-1275
- Coronary plaque disruption.Circulation. 1995; 92: 657-671
- Comparison of coronary plaque rupture between stable angina and acute myocardial infarction: a three-vessel intravascular ultrasound study in 235 patients.Circulation. 2004; 110: 928-933
- Multiple atherosclerotic plaque rupture in acute coronary syndrome: a three-vessel intravascular ultrasound study.Circulation. 2002; 106: 804-808
- Morphologic and angiographic features of coronary plaque rupture detected by intravascular ultrasound.J Am Coll Cardiol. 2002; 40: 904-910
Schwartz GG, Olsson AG, Ezekowitz MD, et al., for the MIRACL study investigators. Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIRACL study: a randomized controlled trial. JAMA 2001;285:1711–8.
Cannon CP, Braunwald E, McCabe CH, et al., for the PROVE-TIMI 22 investigators. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med 2004;350:1495–504.
- Current concepts in cardiovascular pathology: the role of LDL cholesterol in plaque rupture and stabilization.Am J Med. 1998; 104: 14S-18S
- Evolution of spontaneous atherosclerotic plaque rupture with medical therapy: long-term follow-up with intravascular ultrasound.Circulation. 2004; 110: 2875-2880
- The site of plaque rupture in native coronary arteries: a three-vessel intravascular ultrasound analysis.J Am Coll Cardiol. 2005; 46: 261-265
- Long-term follow-up after percutaneous transluminal coronary angioplasty was not performed based on intravascular ultrasound findings: importance of lumen dimensions.Circulation. 1999; 100: 256-261
- American College of Cardiology clinical expert consensus document on standards for acquisition, measurement and reporting of intravascular ultrasound studies (IVUS): a report of the American College of Cardiology task force on clinical expert consensus documents.J Am Coll Cardiol. 2001; 37: 1478-1492
- Intravascular ultrasound analysis of infarct-related and non-infarct-related arteries in patients who presented with an acute myocardial infarction.Circulation. 2003; 107: 2889-2893
- Healed plaque ruptures and sudden coronary death: evidence that subclinical rupture has a role in plaque progression.Circulation. 2001; 103: 934-940
- Mechanisms of progression in native coronary artery disease: role of healed plaque disruption.Heart. 1999; 82: 265-268
- Evidence of multifocal activity of coronary disease in patients with acute myocardial infarction.Circulation. 1997; 96: 1145-1151
- Rapid angiographic progression of coronary artery disease in patients with angina pectoris: the role of complex stenosis morphology.Circulation. 1995; 92: 2058-2065
- Chronic ulcerated plaques: new insights into the pathogenesis of acute coronary disease.J Invas Cardiol. 1994; 6: 173-185
- Change of multiple complex coronary plaques in patients with acute myocardial infarction: a study with coronary angiography.Am Heart J. 2004; 147: 281-286
- Angioscopic follow-up study of coronary ruptured plaques in nonculprit lesions.J Am Coll Cardiol. 2005; 45: 652-658
- Early statin treatment in patients with acute coronary syndrome: demonstration of the beneficial effect on atherosclerotic lesions by serial volumetric intravascular ultrasound analysis during half a year after coronary event: the ESTABLISH study.Circulation. 2004; 110: 1061-1068
- Regression of coronary atherosclerosis by simvastatin: a serial intravascular ultrasound study.Circulation. 2004; 110: 265-270
- Lipid lowering by simvastatin induces regression of human atherosclerotic lesions: two years’ follow-up by high-resolution noninvasive magnetic resonance imaging.Circulation. 2002; 106: 2884-2887
- Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosis: a randomized controlled trial.JAMA. 2004; 291: 1071-1080
- Suppression of the functionally coupled cyclooxygenase-2/prostaglandin E synthase as a basis of simvastatin-dependent plaque stabilization in humans.Circulation. 2003; 107: 1479-1485
- Statins reduce inflammation in atheroma of nonhuman primates independent of effects on serum cholesterol.Arterioscler Thromb Vasc Biol. 2002; 22: 1452-1458
Article info
Publication history
Published online: April 03, 2006
Accepted:
February 18,
2006
Received in revised form:
December 13,
2005
Received:
October 10,
2005
Identification
Copyright
© 2006 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
