Abstract 16193: Greater Benefit of Anti-Atherosclerotic Therapies in Patients with A Recent Acute Coronary Syndrome
Background: Intensive modification of risk factors slows progression of coronary atherosclerosis. The current study investigated whether patients with a recent acute coronary syndrome (ACS) derive a greater benefit with the use of established medical therapies.
Methods: 676 abdominally obese patients with coronary artery disease underwent serial evaluation of coronary atheroma burden with intravascular ultrasound in the STRADIVARIUS study. Disease progression in those with (n=181) and without (n=495) a recent ACS was compared.
Results: ACS patients were more likely to receive anti-platelet therapy (98 vs. 95%, P=0.05), beta-blockers (81 vs. 74%, P=0.04) and high dose statin (43 vs. 33%, P=0.03). ACS patients had more extensive atherosclerosis at baseline with a greater percent atheroma volume (PAV, 38.6±7.4 vs. 37.1±7.8%, P=0.02). Greater reductions in the inflammatory factors, TNF-alpha (median [IQR], −0.23 [−0.59, 0.08] vs. −0.13 [−0.45, 0.17 pg/ml], P = 0.04) and VCAM-1 (−62.7 [−154.8, 30.4] vs. −29.2 [−94.7, 45.5 ng/ml], P = 0.006) were observed in ACS patients. ACS patients demonstrated less progression of PAV (0.05 ± 0.20 % vs. 0.50 ± 0.12%, P=0.05) and total atheroma volume (−3.2 ± 1.4 mm3 vs. +0.4 ±0.8mm3, P=0.02). Propensity score matching demonstrated less progression of PAV in ACS patients (−0.20 ± 0.23 % vs. 0.58 ± 0.23 %, P=0.019). Interesting particular, while intensive LDL-C lowering was universally beneficial, the impact was greatest in those patients with a recent ACS (Figure).
Conclusions: Patients with a recent ACS have more extensive atherosclerosis but less disease progression in response to use of medical therapies. This highlights the incremental benefit of intensive risk factor modification in ACS patients.
- © 2010 by American Heart Association, Inc.