Effects of intensive lipid-lowering therapy on coronary plaques composition in patients with acute myocardial infarction: Assessment with serial coronary CT angiography
Effects of intensive lipid-lowering therapy on coronary plaques composition in patients with acute myocardial infarction: Assessment with serial coronary CT angiography
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DOI：
10.1016/j.atherosclerosis.2015.06.007
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发表时间：
2015-08-01
期刊：
影响因子：
5.3
通讯作者：
Egstrup, Kenneth
中科院分区：
文献类型：
--
作者：
Auscher, Soren;Heinsen, Laurits;Egstrup, Kenneth
背景：他汀类药物已被证明对心血管系统具有良好的作用，可以稳定脆弱的斑块。我们试图通过冠状动脉CT血管造影(CTA)的系列评估来评估早期积极的他汀类药物治疗对急性心肌梗死(AMI)患者斑块组成的影响。方法：在一项前瞻性随机、盲目终点试验中，根据目前的指南，AMI患者被随机分为他汀类药物强化治疗组(80 mg/d)、40 mg/d组(40 mg/d)或标准他汀组(根据现行指南)。在基线和12个月后对患者进行CTA评估，评估斑块的体积和组成。结果：总共140例急性心肌梗死患者被随机分为96例，进行斑块组成评估。重症监护组随访12个月低密度脂蛋白水平中位数为1.3[0.9；1.5]mm o l/L，常规护理组为2.0[1.7；2.4]mm o l/L，P<；12个月后，重症监护组和普通护理组的钙质成分发生变化，总密度钙体积增加11.1(+/-39.6)mm(3)，增加23%，而普通护理组减少-0.4(+/-26.6)mm(3)，P<；0.001。坏死灶体积在重症监护组增加2 6.8(+/-122.1)mm(3)，在常规护理组增加2 5.2(+/-80.1)mm(3)，P=0.94。结论：急性心肌梗死患者早期积极降脂治疗可显著增加致密钙容量。(C)2015爱思唯尔爱尔兰有限公司。保留所有权利。
Background: Statins have been shown to possess favourable effects on the cardiovascular system with stabilization of the vulnerable plaque. We sought to assess the effects of early aggressive statin treatment on plaque composition in patients with acute myocardial infarction (AMI), using serial assessment with coronary CT-angiography (CTA).Methods: In a prospective randomized blinded endpoint trial patients with AMI were randomized to an intensive lipid lowering treatment receiving statin loading with 80 mg rosuvastatin followed by 40 mg daily or standard statin therapy according to current guidelines. Patients were assessed with CTA at baseline and after 12 months with evaluation of plaque volume and composition.Results: In total, 140 patients with AMI were randomized and plaque composition was assessed in 96 patients. In the intensive care group LDL-level was median 1.3 [0.9; 1.5] mmol/l at 12 months follow-up and 2.0 [1.7; 2.4] mmol/l in the usual care group, p < 0.001.Plaque volume increased over 12 months with 43.5 (+/- 225.8) mm(3) in the intensive care group and 19.1 (+/- 190.2) mm(3) in the usual care group, p = 0.57.Plaque composition changed over 12 months with an increase in total dense calcium volume by 11.1 (+/- 39.6) mm(3), corresponding to a 23% increase, in the intensive care group and a decreased by -0.4 (+/- 26.6) mm(3) in the usual care group, p < 0.001. Necrotic core volume increased 26.8 (+/- 122.1) mm(3) in the intensive care group and 25.2 (+/- 80.1) mm(3) in the usual care group, p = 0.94.Conclusions: Early aggressive lipid lowering therapy significantly increases dense calcium volume in patients with AMI. (C) 2015 Elsevier Ireland Ltd. All rights reserved.