Clinical Predictors for Lack of Favorable Vascular Response to Statin Therapy in Patients With Coronary Artery Disease: A Serial Optical Coherence Tomography Study.
Clinical Predictors for Lack of Favorable Vascular Response to Statin Therapy in Patients With Coronary Artery Disease: A Serial Optical Coherence Tomography Study.
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DOI：
10.1161/jaha.117.006241
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发表时间：
2017-11-01
影响因子：
5.4
通讯作者：
Jang IK
中科院分区：
文献类型：
--
作者：
Minami Y;Wang Z;Aguirre AD;Ong DS;Kim CJ;Uemura S;Soeda T;Lee H;Fujimoto J;Jang IK
先前的研究表明，他汀类药物治疗可能通过稳定冠状动脉疾病患者的薄帽纤维粥样斑块来改善心脏结局。然而，尽管接受了他汀类药物治疗，一些患者仍然会发生严重的心脏不良事件。本研究的目的是确定冠状动脉疾病患者对他汀类药物治疗缺乏良好血管反应的临床预测因素。总共纳入了来自 84 名冠状动脉疾病患者的 140 个非罪犯斑块，这些患者接受了他汀类药物治疗并进行了连续光学相干断层扫描成像（中位间隔为 6.3 个月）。使用新型 3 维计算机辅助算法测量薄帽面积（纤维帽厚度，<200 μm）。总体而言，从基线（中位数，2.852 mm2；第 25-75 个百分位数，1.023-6.157 mm2）到随访（中位数，1.210 mm2；第 25-75 个百分位数，0.250-3.192 mm2；P<0.001），薄帽面积显着下降，低密度脂蛋白胆固醇较基线显着下降（平均值±SD，92.9±30.1 mg/dL）到随访（平均值±SD，76.3±23.3 mg/dL；P<0.001）。具有多个预测变量的一般线性模型显示，慢性肾病患者的薄帽面积显着高于无慢性肾病患者（回归系数 b，1.691 mm2；95% 置信区间，0.350–3.033 mm2；P=0.013），而急性冠状动脉综合征患者则较低（回归系数 b，-1.535 mm2；95% 置信区间，-2.561 至-0.509mm2；P=0.003)。慢性肾病是对他汀类药物治疗缺乏良好的血管反应的独立预测因素，而急性冠状动脉综合征是对他汀类药物治疗的良好血管反应的独立预测因素。这些发现应该在未来的前瞻性研究中得到进一步证实。网址：http://www.clinicaltrials.gov。唯一标识符：NCT01110538。
Previous 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. A 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). Chronic 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. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01110538.