Clinical Predictors for Lack of Favorable Vascular Response to Statin Therapy in Patients With Coronary Artery Disease: A Serial Optical Coherence Tomography Study.
BACKGROUND
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.


METHODS AND RESULTS
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).


CONCLUSIONS
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.


CLINICAL TRIAL REGISTRATION
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01110538.
['Minami|Yoshiyasu|Y|', 'Wang|Zhao|Z|', 'Aguirre|Aaron D|AD|', 'Ong|Daniel S|DS|', 'Kim|Chong-Jin|CJ|', 'Uemura|Shiro|S|', 'Soeda|Tsunenari|T|', 'Lee|Hang|H|', 'Fujimoto|James|J|', 'Jang|Ik-Kyung|IK|']
D054058:Acute Coronary Syndrome D000368:Aged D001208:Asia D016009:Chi-Square Distribution D003324:Coronary Artery Disease D003331:Coronary Vessels D016208:Databases, Factual D005260:Female D005355:Fibrosis D006801:Humans D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors D007090:Image Interpretation, Computer-Assisted D021621:Imaging, Three-Dimensional D016014:Linear Models D008297:Male D008875:Middle Aged D058226:Plaque, Atherosclerotic D011237:Predictive Value of Tests D012042:Registries D051436:Renal Insufficiency, Chronic D012189:Retrospective Studies D012307:Risk Factors D013997:Time Factors D041623:Tomography, Optical Coherence D017211:Treatment Failure
statin therapy coronary artery disease optical coherence tomography fibrous cap atherosclerosis