[Show abstract][Hide abstract] ABSTRACT: Background
Many trials have shown that statins can reduce plaque volume (PV) associated with the degree of LDL-C reduction.
The goal of this study is to determine whether the combination of ezetimibe and a statin produces greater reductions in coronary plaque volume compared to statin monotherapy in patients with acute coronary syndrome (ACS).
Prospective serial intravascular ultrasound (IVUS) of non-culprit lesions of the target vessel was performed in 95 patients with ACS. Of these, 50 patients were administered combination of atorvastatin 20 mg/day and ezetimibe 10 mg/day. 45 subjects treated by atorvastatin 20 mg/day alone were the control group. At the beginning and 24 weeks after PCI, quantitative PV was accessed by IVUS. The primary end point was the percentage change in non-culprit coronary PV.
LDL-C was significantly decreased by 49.8% in the ezetimibe/atorvastatin group compared with 34.6% in the atorvastatin group. Significant regression of plaque volume was observed from baseline to follow-up in both groups. The percentage changes in PV were greater in the ezetimibe/atorvastatin group than in the atorvastatin alone group (12.5% versus 7.6%, p = 0.06), but statistically not significant. In 34 diabetic patients, regression of PV was significantly greater in the ezetimibe/atorvastatin group than in the statin alone group (13.9% versus 5.1%, p = 0.04) and % change of PV significantly correlated with LDL-C reduction.
Additional LDL-C reduction with combination therapy tended to reduce more plaque regression compared to a statin alone in patients with ACS. In diabetic patients, further reduction of LDL-C was associated with a significantly greater reduction in PV.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Lysophosphatidic acid (LPA) is a platelet activator and highly thrombogenic lipid constituent of atherosclerotic plaque. However, whether or not LPA locally released from culprit lesions is associated with acute coronary syndrome (ACS) remains unclear. METHODS: We studied 52 patients with ACS who were treated by emergency percutaneous coronary intervention and thrombectomy. Levels of LPA and other established biomarkers were enzymatically assayed in samples of culprit coronary arterial and systemic peripheral arterial blood. Levels of LPA and lysophosphatidylcholine (LPC) were measured in plasma, and those of autotaxin, soluble CD40 ligand (sCD40L), hs-CRP and Lp-PLA2 were measured in serum. RESULTS: Median LPA levels were significantly higher in coronary (CB) than in peripheral (PB) arterial blood (p = 0.009). Levels of sCD40L were higher in CB than in PB, but the difference did not reach statistical significance (p = 0.177). In contrast, autotaxin and Lp-PLA2 levels were significantly higher in PB than in CB (p = 0.005 and p = 0.038, respectively). Levels of LPC and hs-CRP were also higher in PB than in CB (p = 0.129 and p = 0.121, respectively). Levels of LPA in both CB and PB were positively and significantly associated with those of LPC (r = 0.632, p < 0.01 and r = 0.465, p < 0.001). CONCLUSIONS: Culprit coronary arteries of ACS contained significantly more LPA than the systemic arterial circulation. Higher LPA concentrations might be associated with the pathophysiology of ACS.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: LR11 is a novel marker of intimal smooth muscle cell (SMC) proliferation. Vascular SMCs play important roles in the development of atherosclerosis interacting with macrophages in vulnerable plaque of patients with acute coronary syndrome (ACS).The present study determines whether soluble LR11 (sLR11) is associated with ACS. METHODS: We studied 100 patients with coronary artery disease (CAD) comprising 50 consecutive patients with acute coronary syndrome (ACS; mean age 62.3±13.0 y; male 78.0%) who were successfully treated with percutaneous coronary intervention and 50 age- and sex-matched stable angina pectoris (SAP) patients as control. Concentration of sLR11 was measured by sandwich enzyme-linked immunosorbent assay method. RESULTS: Circulating sLR11 was significantly increased in patients with ACS compared with SAP (9.88±2.78 vs. 8.18±1.11ng/ml, p<0.01). Multivariate logistic regression analysis indicated that sLR11 was independently associated with ACS (odds ratio (OR), sLR11 quartile increment, 2.18, 95% confidence interval (CI) 1.21-4.19, p<0.01). Among various biomarkers of acute coronary syndrome, hsCRP were significantly correlated with LR11 (r=0.480, p<0.01). CONCLUSIONS: There is a statistical significant association between LR11 and ACS and may be a useful biomarker for the development of acute coronary syndrome.
Clinica chimica acta; international journal of clinical chemistry 11/2012; · 2.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Red blood cell distribution width (RDW) is a novel prognostic marker that reflects oxidative stress and chronic inflammation in patients with cardiovascular disease. Diabetes mellitus increases oxidative stress and vascular inflammation, which accelerate atherosclerosis. However, the relationship between RDW and long-term outcome in diabetic patients with coronary artery disease (CAD) is unclear. Methods and Results: Subjects comprised 560 consecutive diabetic patients (mean age, 66.6 years; male, 80%) with stable CAD who had undergone elective percutaneous coronary intervention (PCI). Patients were divided into 2 groups according to median RDW at baseline (13.1%): a high RDW group (mean RDW, 14.0%; interquartile range, 13.3-14.2%); and a low RDW group (mean RDW, 12.6%; interquartile range, 12.4-12.9%). All-cause mortality rates were compared between groups. Mean duration of follow up was 3.9 years. Patients with high RDW were more likely to be older, show dyslipidemia and have a lower ejection fraction and decreased hemoglobin level. Twenty-nine patients (5.2%) died during follow up. The cumulative incidence of all-cause death was significantly higher in the high RDW group than in the low RDW group (log-rank P=0.0015). Multivariate analysis identified high RDW as being associated with all-cause mortality (hazard ratio, 2.56; 95% confidence interval, 1.12-6.62; P=0.025). Conclusions: Increased RDW was significantly associated with increased long-term all-cause mortality in diabetic patients after PCI.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Lipoprotein-associated phospholipase A2 (Lp-PLA2) has been proposed as an inflammatory marker of cardiovascular disease. The present study investigates associations between Lp-PLA2 and other important biomarkers in Japanese patients with coronary artery disease. METHODS: We measured Lp-PLA2 levels in 141 consecutive patients (age 62.6 ± 3.8 years; men 69.2%) with angiographic evidence of coronary artery disease (acute coronary syndrome [ACS]; n = 38), stable angina pectoris (SAP; n = 72) or with angiographically normal coronary arteries (NCA; n = 31). RESULTS: Levels of Lp-PLA2 significantly correlated with low-density lipoprotein-cholesterol (r = 0.302), homocysteine (r = 0.528) and paraoxonase (r = 0.401) in all patients (all P < 0.01). Levels of Lp-PLA2 were significantly higher in patients with coronary atherosclerosis (ACS and SAP) than with NCA (P < 0.05). Levels of highly sensitive C-reactive protein were significantly higher in patients with ACS than with SAP and NCA (both P < 0.05). Multivariate logistic regression analyses revealed that higher Lp-PLA2 levels were independently associated with coronary atherosclerosis (odds ratio: 1.058; 95% confidence interval: 1.012-1.121; P = 0.001). CONCLUSIONS: Higher Lp-PLA2 levels are associated with coronary atherosclerosis independently of traditional coronary risk factors. Thus, Lp-PLA2 is a novel biomarker of coronary atherosclerosis in Japanese patients.
Annals of Clinical Biochemistry 08/2012; · 1.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Off-pump coronary artery bypass surgery and sirolimus-eluting stent placement have been widely used for the treatment of coronary artery disease. The goal of this study was to compare long-term outcomes after off-pump coronary artery bypass surgery or sirolimus-eluting stent placement in diabetic patients with multivessel disease.
This observational study enrolled 350 off-pump coronary artery bypass patients and 143 sirolimus-eluting stent patients receiving care at our institution between 2000 and 2007. All patients had diabetes and multivessel disease including proximal left anterior descending or left main coronary artery. The choice of revascularization (percutaneous coronary intervention versus coronary artery bypass surgery) was left to the physician's discretion rather than randomization. Cox proportional-hazard analyses, adjusting baseline risk factors and propensity score, which predicted the probability of receiving off-pump coronary artery bypass, were conducted to evaluate outcomes, including all-cause mortality, cardiac death, target vessel revascularization, and major adverse cardiac and cerebrovascular events.
During the follow-up (2.6±1.6 years) period, there was no difference between off-pump coronary artery bypass and sirolimus-eluting stent placement in all-cause mortality or cardiac death. However, the incidences of acute coronary syndrome, target vessel revascularization, and major adverse cardiac and cerebrovascular events were markedly lower in the patients undergoing off-pump coronary artery bypass than in those receiving sirolimus-eluting stent placement.
Off-pump coronary artery bypass is superior to sirolimus-eluting stent placement in terms of acute coronary syndrome, target vessel revascularization, and major adverse cardiac and cerebrovascular events in diabetic patients with multivessel coronary artery disease.
Journal of Cardiology 03/2012; 59(2):195-201. · 2.30 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The platelet activator lysophosphatidic acid (LPA) has recently been identified as an ingredient in oxidized LDL and it has been isolated from atherosclerotic plaques. The lysophospholipase D activity of autotaxin produces LPA extracellularly from lysophosphatidylcholine (LPC). The present study determines whether circulating LPA is associated with acute coronary syndrome (ACS).
We enrolled 141 consecutive patients (age, 62.6±3.8 y; male, 69.2%) with ACS (n=38), stable angina pectoris (SAP; n=72) or angiographically normal coronary arteries (NCA; n=31). The relationships between LPA and other established biomarkers were examined. Concentrations of plasma LPA were determined using an enzymatic assay.
Concentrations of LPA significantly correlated with LPC (r=0.549), autotaxin (r=0.370) and LDL-C (r=0.307) (all p<0.01). Lysophosphatidic acid concentrations were significantly higher in patients with ACS than with SAP and NCA (p<0.01), but did not significantly differ between patients with SAP and NCA. Multivariate logistic regression analyses revealed that the highest LPA tertile was independently associated with ACS (odds ratio 1.99, 95% CI: 1.18-3.39, p=0.02).
The present study demonstrated that increased circulating plasma LPA concentrations are significantly associated with ACS.
Clinica chimica acta; international journal of clinical chemistry 01/2012; 413(1-2):207-12. · 2.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a vascular-specific inflammatory enzyme, of which increases are associated with cardiovascular events. However, the relationship between circulating Lp-PLA2 levels and coronary plaque volume has not been clarified in patients with acute coronary syndrome (ACS).
We studied 40 patients with ACS (age, 61.4 ± 8.0 years; male, 87.5%; statin use, 45.0%) who had undergone successful percutaneous coronary intervention (PCI). Plaque volume (PV) in non-culprit sites of PCI lesions was precisely determined using grayscale intravascular ultrasound (IVUS) at onset and at six months later. We then analyzed associations among PV, lipid profiles and Lp-PLA2 levels.
Circulating Lp-PLA2 levels and PV significantly decreased between baseline and six months of follow-up (458.6 ± 166.7 IU/L vs. 378.4 ± 158.5 IU/L, p < 0.001 and 82.2 ± 34.8mm(3) vs. 77.3 ± 33.1mm(3), p < 0.001, respectively). The % change in PV positively and significantly correlated with % change in LDL-C and in the LDL-C/HDL-C ratio (r = 0.444, p = 0.004 and r = 0.462, p = 0.003, respectively). Furthermore, % changes in Lp-PLA2 and in PV correlated even more closely (r = 0.496, p = 0.001). The absolute change in PV also significantly correlated with the change in Lp-PLA2 levels (r = 0.404, p = 0.009).
Circulating Lp-PLA2 levels are associated with changes in coronary plaque determined by IVUS in patients with ACS.
[Show abstract][Hide abstract] ABSTRACT: Metabolic syndrome (MS) plays a crucial role in the long-term prognosis and primary or secondary prevention of coronary artery disease, regardless of the presence or absence of diabetes mellitus (DM). We previously reported that after percutaneous coronary intervention (PCI), patients with MS had worse long-term outcome. However, there is no evidence indicating the importance of MS with and without DM on re-revascularization procedures in Japanese patients undergoing PCI.
We hypothesized that MS patients without DM have an increased risk of re-revascularization following PCI.
We classified 748 consecutive Japanese patients who had undergone PCI into 4 groups as follows: neither DM nor MS, DM alone, MS alone, and both DM and MS. Post-hoc analyses were conducted using prospectively collected clinical data. Multivariate Cox regression was used to evaluate the risk within each group for subsequent revascularization (repeat PCI and bypass surgery), adjusting for baseline covariates.
The progress of 321 (42.9%) patients without DM or MS, 109 (14.6%) patients with DM alone, 129 (17.2%) patients with MS alone, and 189 (25.3%) patients with both DM and MS was followed up for a mean duration of 12.0 ± 3.6 years. Patients with MS alone (hazard ratio: 1.38, 95% confidence interval: 1.01-1.89, P = 0.04) and those with both DM and MS (hazard ratio: 1.36, 95% confidence interval: 1.02-1.81, P = 0.04) had a significantly increased risk for revascularization.
The presence of MS significantly increased the risk for subsequent revascularization among Japanese patients who underwent PCI, regardless of the presence or absence of DM.
[Show abstract][Hide abstract] ABSTRACT: In-stent restenosis (ISR) after bare-metal stent (BMS) implantation is thought to be clinically benign, although this notion remains controversial. The long-term clinical outcomes of ISR with BMS have not been established.
Among 983 consecutive patients (1,227 lesions) implanted with a BMS between 1999 and 2004 at the authors' institution, 746 underwent routine follow-up angiography. Angiographic ISR (ISR group) was evident in 215 patients (28.8%) and 136 of them underwent repeat revascularization. The incidence of major adverse cardiac events (MACE), acute coronary syndrome (ACS), target lesion revascularization and all-cause death were evaluated between patients with and without ISR (non-ISR group). Patients in the ISR group were older and more likely to have diabetes. The median follow-up period was 2,031 days. The rates of MACE and ACS were significantly higher in the ISR group compared with the non-ISR group (33.5% vs. 13.7%, P<0.0001 and 11.2% vs. 7.0%, P<0.05, respectively). Multivariate Cox regression analysis demonstrated that ISR was significantly associated with clinical outcomes (adjusted hazard ratio [HR] for MACE, 2.81; 95% confidence interval [CI]: 2.01-3.94, P<0.01; adjusted HR for ACS, 1.84; 95%CI: 1.08-3.13, P<0.05).
ISR with BMS was significantly associated with long-term adverse clinical outcomes. Risk of future cardiovascular events due to ISR must be carefully considered.
[Show abstract][Hide abstract] ABSTRACT: Although coronary artery disease (CAD) is less prevalent in women than in men, early mortality rate is higher in women with CAD than in men with CAD following coronary revascularization. In terms of the long-term outcomes after coronary revascularization, limited data are available. Especially, in the Japanese CAD population, no data about sex-related differences in long-term outcomes after coronary revascularization exist. The aim of this study was to compare long-term outcomes between men and women following complete revascularization in Japanese patients with CAD.
We collected data from 1836 consecutive patients who underwent complete revascularization by percutaneous coronary interventions and/or bypass surgeries. All-cause and cardiac mortality and the incidence of stroke were compared between men and women. In addition to the univariate analysis, a multivariate Cox regression was carried out in order to adjust for differences in baseline characteristics.
There were 274 female patients (14.9%). They were older, had greater total cholesterol levels, and were more likely to have multivessel disease than men. During follow-up [mean (SD), 11.4 (2.9) years], 412 patients died (including 131 patients who died of cardiac causes), and 130 had a stroke. In the multivariate analysis, female patients did not have a significant risk for all-cause mortality (hazard ratio [HR], 1.01; p=0.993), cardiac mortality (HR, 1.41; p=0.256), or stroke (HR, 0.71; p=0.309).
In the present study involving CAD patients who underwent complete revascularization, we showed that, although women were older and had more unfavorable risk profiles, they did not have a greater risk of long-term all-cause mortality, cardiac mortality, or stroke incidence, compared to men.
Journal of Cardiology 07/2011; 58(2):158-64. · 2.30 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A previous study reported that amlodipine retarded coronary plaque progression in patients with coronary artery disease. The goal of this multicenter study was to determine which calcium-channel blockers (CCBs) other than amlodipine attenuated the progression of plaque volume (PV) accessed by intravascular ultrasound (IVUS).
ALPS-J was a prospective, randomized open-label study conducted at 5 centers. Patients who had hypertension and were scheduled for coronary intervention were enrolled. Subjects were randomly assigned to receive 16 mg/day of azelnidipine or 5mg/day of amlodipine administered for 48 weeks. The primary endpoint was the percent change in coronary PV measured by IVUS. Between 2007 and 2009, 199 patients were enrolled; 115 had evaluable IVUS images at both baseline and after 48 weeks of treatment. Blood pressure significantly reduced to 128/68 mmHg at follow-up. The lipid profiles in the 2 groups were comparable (low-density lipoprotein cholesterol: 97 mg/dl). The %change in PV showed a significant regression of 4.67 and 4.85% in the azelnidipine and amlodipine groups, respectively. The upper limit of the 95% confidence interval of the mean difference in %change PV between the 2 groups (0.18%, 95% confidence interval 4.62 to 4.98%) did not exceed the pre-defined non-inferiority margin of 6.525%.
ALPS-J demonstrated that azelnidipine was not inferior to amlodipine for primary efficacy. In addition to standard medical therapy, dihydropyridine CCBs will retard PV progression in hypertensive patients.
[Show abstract][Hide abstract] ABSTRACT: Accumulating evidence shows that chronic kidney disease (CKD) is an independent risk factor for major adverse cardiac and cerebrovascular events (MACCE) after acute coronary syndrome (ACS). However, it is not known whether mild renal insufficiency affects long-term clinical outcomes.
This is a post-hoc analysis from the Extended-ESTABLISH trial, which was designed to estimate the impact of renal insufficiency on patients with ACS after percutaneous coronary intervention over the long term. One hundred and eighty patients were divided into three groups based on the estimated glomerular filtration rate (eGFR) at time of ACS: moderate-to-severe CKD, <60 mL/min/1.73 m(2) (n = 31, 17.2%); mild CKD, 60-90 mL/min/1.73 m(2) (n = 100, 55.6%) and non-CKD, ≥90 mL/min/1.73 m(2) (n = 47, 26.1%). The eGFR was calculated using the new Japanese equation. Long-term outcomes were compared over a follow-up period of 1538 ± 707 days.
Cumulative incidence rates of MACCE did not significantly differ between groups 1 year after ACS onset (P = 0.384), whereas significant differences appeared during the long-term follow-up (10.6 versus 27.0% versus 35.4% in the non-CKD, mild CKD and moderate-to-severe CKD groups, respectively; log-rank test, P = 0.022). In a multivariate Cox hazard regression model, moderate-to-severe CKD and mild CKD were associated with a higher rate of MACCE after adjusting for confounding variables (hazard ratios = 3.46 and 2.67, respectively; P = 0.043).
The presence of mild CKD at ACS occurrence is associated with a worse outcome in the long term, but not the short term.
[Show abstract][Hide abstract] ABSTRACT: The left internal thoracic artery (LITA) is the conduit of choice for coronary artery bypass (CABG) due to favorable long-term patency. Uncommonly, diffuse narrowing like a string without significant stenosis of an anastomosis is observed in the LITA graft (called "string sign"). Isolated left main trunk (LMT) diseases were reported to regress in some cases. However, the relationship between "string sign" and the regression of solitary LMT disease remains unknown.We retrospectively studied 40 consecutive patients with isolated LMT stenosis who underwent CABG using LITA and who underwent angiography before and after operation (31 males, 9 females, mean age, 65.0 years). The patients were divided into 2 groups according to the postoperative angiographic outcomes of the LITA graft: one group included patients with "string sign" (6 patients), the other group consisted of patients with a patent LITA graft (34 patients).There were no significant differences in clinical backgrounds between the two groups. The 2 groups showed similar quantitative % coronary artery stenosis of the LMT before operation (77.5% versus 76.8%) and the observation period was similar in both groups. Coronary angiography after CABG revealed that % stenosis of the LMT in patients with "string sign" was significantly less than that in patients with a patent LITA graft (41.7 ± 26% versus 82.5 ± 11%, P < 0.001). Regression in LMT was significantly more frequently observed in the "string sign group". Furthermore, ostial stenosis was more frequent in patients with "string sign". "String phenomenon" of the LITA graft is one of the signs related to the regression of LMT stenosis, and especially in ostial stenosis of the LMT.
International Heart Journal 01/2011; 52(2):84-7. · 1.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Diabetes mellitus has a greater effect on mortality rates due to coronary artery disease in women than in men. Although women undergoing coronary intervention in general have a higher frequency of adverse outcomes than men, the effect of gender among diabetic patients on clinical outcomes after percutaneous coronary intervention (PCI) has not been well established in the drug-eluting stent (DES) era. We have investigated the impact of gender on long-term clinical outcome in these high risk populations. We enrolled 404 consecutive patients (74 women and 330 men) with diabetes mellitus who underwent elective PCI (85% with DES). We evaluated the incidence of major adverse cardiac events (MACE), which is a composite of total all-cause death, acute coronary syndrome (ACS), and target lesion revascularization (TLR) during a period of 4 years after coronary intervention. The women were significantly older, more likely to have dyslipidemia, and had significantly higher systolic blood pressure and LDL-C values than men. The use of insulin and angiotensin receptor blockers was more frequent among the women (32.4% versus 21.0%, P = 0.04 and 60.8% versus 39.8%, P < 0.01, respectively). The angiographic profiles of both were comparable. At four-year clinical follow-up, cumulative incidence of MACE was identical between the women and the men (16.2% versus 15.5%, P = 0.90; adjusted HR 1.23, 95% CI 0.61-2.50, P = 0.56). Although the baseline characteristics of the women were worse, clinical outcomes did not significantly differ between women and men among diabetic patients after elective PCI.
International Heart Journal 01/2011; 52(6):348-52. · 1.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: 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.
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.
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).
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.
Journal of atherosclerosis and thrombosis 12/2010; 18(3):231-9. · 2.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Some randomized studies have shown a delay of up to a few years in the statin-related survival advantage, whereas others have demonstrated an early survival benefit for some patients. We examined the short-term effects of statins in patients with acute coronary syndrome (ACS), stratified according to baseline LDL-C.
Patients with ACS (n = 180) were randomized to receive 6 months of atorvastatin (20 mg) in the Extended-ESTABLISH trial. Six months after ACS onset, all patients were treated with statins to achieve an LDL-C value of < 100 mg/dL. Patient outcomes were analyzed with respect to LDL-C at the time of ACS onset: high baseline (≥ 100 mg/dL, n = 124) or low baseline (< 100 mg/dL, n = 56) LDL-C.
The cumulative incidence rates of major adverse cardiac and cerebrovascular events (MACCE) did not significantly differ between the early-statin and control groups in the high baseline groups at 6 months (p = 0.158), whereas a significant benefit of early intensive statins appeared 1 year (p = 0.034) later. In contrast, we found no significant short-term benefits of statins after either 6 months or 1 year in the low baseline group. Multivariate analysis showed that early intensive atorvastatin therapy was associated with a lower risk of MACCE at 1 year in the high baseline group (OR, 0.25; 95% CI, 0.05 to 0.83; p = 0.035).
The effects of 6 months of intensive lipid-lowering therapy appear after 1 year in patients with ACS and baseline LDL-C ≥ 100 mg/dL.
Journal of atherosclerosis and thrombosis 10/2010; 18(1):42-8. · 2.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The ESTABLISH trial found using volumetric intravascular ultrasound that atorvastatin therapy started early and continued for 6 months significantly reduced plaque volume in patients with acute coronary syndrome (ACS). However, the benefits of early statin administration on long-term outcomes remain unclear. We therefore examined whether the early initiation of statin in patients with ACS improves long-term prognosis.
The Extended-ESTABLISH trial included 180 patients with ACS who underwent emergency percutaneous coronary intervention (PCI). These patients were randomized here to groups given either early intensive lipid-lowering therapy (n=90; atorvastatin 20 mg/day) or standard care (control, n=90) within 48 h of events. Baseline characteristics between the two groups did not significantly differ at the time of ACS onset. Six months after PCI, all patients were treated with statins to achieve an LDL-C value of <100 mg/dL. We compared the first occurrence of major adverse cardiac and cerebrovascular events (MACCE). Prognostic data were fully documented during the entire follow-up period (mean, 1538+/-707 days). Cumulative event-free survival was significantly higher in the atorvastatin, than in the control group (p=0.041; log-rank test). Furthermore, by adjusting for validated prognosticators, early statin administration was identified as a good predictor of MACCE (HR 0.46, 95%CI 0.23-0.86; p=0.015).
In-hospital initiation of statin therapy immediately after ACS conferred long-term benefits and 6 months of intensive lipid-lowering therapy improved long-term clinical outcomes after PCI in patients with ACS.
[Show abstract][Hide abstract] ABSTRACT: The long-term effect of statin therapy in diabetic patients after coronary revascularization is not well established. Accordingly, we sought to determine if whether statin therapy initiated at the time of complete revascularization including percutaneous coronary intervention (PCI) and/or bypass surgery reduces total and cardiac mortality among diabetic patients.
We collected data from 1,138 consecutive patients who underwent complete revascularization (PCI and/or bypass surgery). We then compared all-cause and cardiac mortality rates in 499 patients with diabetes mellitus of whom 149 (29.9%) were treated with statin at the time of revascularization. To adjust the variables that would have been related to the decision regarding statin administration, a propensity score was computed and multivariate Cox regression was carried out.
During follow-up (8.8+/-2.6 years), 103 patients died (including 43 who died of cardiac causes). The Multivariate analysis showed statin therapy to be significantly associated with reduced cardiac mortality (HR 0.39, 0.16-0.95; p=0.039), but not with all-cause mortality.
Statin therapy was associated with a significantly reduced risk of cardiac mortality in patients with diabetes mellitus and coronary artery disease after complete revascularization.
Journal of atherosclerosis and thrombosis 02/2010; 17(4):350-5. · 2.93 Impact Factor