Abstract 14232: Progression of Native Coronary Artery Disease Measured by Intravascular Ultrasound: Systematic Review and Meta-Analysis
Introduction: Much effort has been made to understand the mechanisms of coronary artery disease (CAD), and to develop therapies to prevent disease progression. Systematic analysis of intravascular ultrasound (IVUS) as a tool to evaluate coronary plaque development pattern over time in the presence or absence of specific therapies is not available.
Objective: To investigate the pattern of coronary plaque volume progression over time by serial IVUS imaging, based on published data from prospective clinical trials.
Methods: Medline search was performed with 6 combinations of MeSH terms including “plaque”, “progression” and “regression”, to identify trials that evaluated volumetric coronary plaque progression by IVUS. Study arms (active treatment or placebo) were pooled, and meta-regression models were applied, considering the IVUS-derived % plaque volume change (%PVC) and absolute change (ΔPV) as the responses, and follow up (FU) time, relevant risk factors and therapies as independent variables.
Results: The search returned 1451 titles; 193 abstracts and 42 papers remained after exclusions, totaling 10169 patients in 86 arms (24 control and 62 treatment), with a mean FU time of 16.3 (0.6 to 36) months. There was significant plaque regression 34 arms (39.5%), and progression in only 7. In the univariate meta-regression (all arms pooled), there was no linear association between %PVC and FU time (β = -0.384/month, p = 0.563), and significant association between statins and % change in LDL (ΔLDL%) and %PVC (β = -3.848, p = 0.008 and β = 2.235, p = 0.002). For the placebo arms, only baseline LDL associated with %PVC. In the multivariate model, FU time also showed no association with %PVC (β = 0.351, p = 0.696). The variables associated with %PVC were also statin test and ΔLDL% (β = -5.099, p = 0.022 and β = 2.045, p = 0.035). There was also no significant linear association between FU time and ΔPV (β = -0.119, p = 0.668).
Conclusion: There seems to be no linear association between %PVC or ΔPV and FU time (with similar findings for control arms), suggesting that regardless of specific therapies, atherosclerotic evolution is not linear in a moderate to high risk population in a time frame of 16.3 months. The use of statins and ΔLDL% had significant association with plaque progression.
- © 2013 by American Heart Association, Inc.