Author + information
- Received April 5, 2018
- Revision received August 6, 2018
- Accepted August 7, 2018
- Published online December 12, 2018.
- Lorenz Räber, MD, PhDa,∗ (, )
- Konstantinos C. Koskinas, MD, MSca,
- Kyohei Yamaji, MD, PhDa,b,
- Masanori Taniwaki, MDa,c,
- Marco Roffi, MDd,
- Lene Holmvang, MD, PhDe,
- Hector M. Garcia Garcia, MD, PhDf,
- Thomas Zanchin, MDa,
- Rafaela Maldonado, MDa,
- Aris Moschovitis, MDa,
- Giovanni Pedrazzini, MDg,
- Serge Zaugg, MSch,
- Jouke Dijkstra, PhDi,
- Christian M. Matter, MDj,
- Patrick W. Serruys, MD, PhDk,
- Thomas F. Lüscher, MDl,
- Henning Kelbaek, MD, PhDm,
- Alexios Karagiannis, PhDh,
- Maria D. Radu, MD, PhDe and
- Stephan Windecker, MDa
- aDepartment of Cardiology, Bern University Hospital, Bern, Switzerland
- bDepartment of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
- cTokorozawa Heart Center, Saitama, Japan
- dDivision of Cardiology, University Hospital Geneva, Geneva, Switzerland
- eHeart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- fMedStar Cardiovacular Research Network, MedStar Washington Hospital Center, Washington
- gCardiocentro, Lugano, Switzerland
- hClinical Trials Unit (CTU), Bern, and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- iLeiden University Medical Center, Leiden, the Netherlands
- jDepartment of Cardiology, Zurich University Hospital, Zurich, Switzerland
- kInternational Centre for Circulatory Health, National Heart and Lung Institute, Imperial College, London, London, United Kingdom
- lRoyal Brompton and Harefield Hospital Trust and Imperial College, London, United Kingdom
- mDepartment of Cardiology, Zealand University Hospital, Roskilde, Denmark
- ↵∗Address for correspondence:
Dr. Lorenz Räber, Department of Cardiology, Bern University Hospital, Freiburgstrasse, 3010 Bern, Switzerland.
Objectives This study assessed changes in optical coherence tomography (OCT)-defined plaque composition in patients with ST-elevation myocardial infarction (STEMI) receiving high-intensity statin treatment.
Background OCT is a high-resolution modality capable of measuring plaque characteristics including fibrous cap thickness (FCT) and macrophage infiltration. There is limited in vivo evidence regarding the effects of statins on OCT-defined coronary atheroma composition and no evidence in the context of STEMI.
Methods In the IBIS-4 (Integrated Biomarker Imaging Study-4), 103 patients underwent intravascular ultrasonography and OCT of 2 noninfarct-related coronary arteries in the acute phase of STEMI. Patients were treated with high-dose rosuvastatin for 13 months. Serial OCT imaging was available in 153 arteries from 83 patients. We measured FCT by using a semi-automated method. Co-primary endpoints consisted of the change in minimum FCT (measured in fibroatheromas) and change in macrophage line arc.
Results At 13 months, median low-density lipoprotein cholesterol had decreased from 128 mg/dl to 73.6 mg/dl. Minimum FCT, measured in 31 lesions from 27 patients, increased from 64.9 ± 19.9 μm to 87.9 ± 38.1 μm (p = 0.008). Macrophage line arc decreased from 9.6° ± 12.8° to 6.4° ± 9.6° (p < 0.0001). The secondary endpoint, mean lipid arc, decreased from 55.9° ± 37° to 43.5° ± 33.5°. In lesion-level analyses (n = 191), 9 of 13 thin-cap fibroatheromata (TCFAs) at baseline (69.2%) regressed to non-TCFA morphology, whereas 2 of 178 non-TCFA lesions (1.1%) progressed to TCFAs.
Conclusions In this observational study, we found significant increase in minimum FCT, reduction in macrophage accumulation, and frequent regression of TCFAs to other plaque phenotypes in nonculprit lesions of patients with STEMI treated with high-intensity statin therapy.
The IBIS-4 trial was funded by Swiss National Science Foundation grants 33CM30-124112 and 310030-118353, St. Jude Medical/Abbott, Zurich, Switzerland, and Biosensors SA, Morges, Switzerland. Dr. Raber has received research grants from St. Jude Medical/Abbott, Sanofi, and Regeneron; and has received speaker fees from Amgen and Astra Zeneca. Dr. Radu has received lecture honoraria from St. Jude Medical/Abbott Vascular; and has received research grants from Abbott Vascular, Terumo, Boston Scientific, Biotronik, and Medtronic. Dr. Lüscher has received research grants and speaker fees from Amgen, AstraZeneca, Bayer Healthcare, Biosensors, Biotronik, Boston Scientific, Eli Lilly, Medtronic, Merck and Co., Roche, and Servier; Dr. Matter has received research grants and speaker fees from and consults for Eli Lilly, AstraZeneca, Roche, Amgen, and Merck and Co. Dr. Windecker has received research contracts from Bracco, Boston Scientific, and St Jude. All other authors have reported that they have no relationships with industry relevant to the contents of this paper to disclose.
- Received April 5, 2018.
- Revision received August 6, 2018.
- Accepted August 7, 2018.
- 2018 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.