Abstract 16218: Long-Term Anti-Atherosclerotic Effects of Maximally Intensive Statin Therapy Following Acute Coronary Syndrome: Insights From SATURN
Background: Patients with ACS display diffuse coronary atheroma instability and a heightened risk of early and late recurrent coronary events. Potent statin therapy reduces recurrent clinical events post-ACS. To gain insight into the mechanisms of these benefits, this study assessed the long-term effects of high-intensity statins on plaques in ACS patients as assessed by intravascular ultrasound (IVUS).
Methods: SATURN employed serial IVUS measures of coronary atheroma volume in patients treated with rosuvastatin 40 mg or atorvastatin 80 mg for 24 months. The treatment groups did not differ in change from baseline of percent atheroma volume (PAV) on IVUS, nor for safety or major adverse cardiovascular events (MACE: death/non-fatal myocardial infarction/coronary revascularization). Patients presenting with myocardial infarction or unstable angina were classified as having ACS.
Results: Compared with non-ACS patients (n=678), ACS patients (n=361) were younger (p<0.001), more likely to be actively smoking (p<0.001), have had a prior myocardial infarction (p<0.001), and at baseline, had lower HDL-C (43.5±11 vs. 45.8±11 mg/dL, p=0.002), ApoA-1 (123.1±24 vs. 129±24 mg/dL, p<0.001), higher ApoB:A-1 ratio (0.90±0.24 vs. 0.83±0.24, p<0.001) and greater PAV (37.7±8.4 vs. 35.8±8.1%, p<0.001). Following 24-months of high-intensity statin therapy, all lipoprotein and C-reactive protein levels became similar in each group. Compared with non-ACS patients, those with ACS had greater PAV regression than non-ACS patients (-1.45±0.16 vs. -1.02±0.11%, p=0.03). Multivariable analysis following propensity-weighting adjustment revealed baseline PAV (β = -0.64, p<0.001), and an ACS clinical presentation (β = -0.44, p=0.025) to independently associate with coronary atheroma regression. The 24-month MACE-free survival was similar between ACS and non-ACS patients (92.1 vs. 94.4%, p=0.20).
Conclusion: Despite ACS patients demonstrating greater systemic risk than their non-ACS counterparts, potent statin therapy produced greater plaque regression and similar MACE-free survival, compared with non-ACS patients. These direct effects on plaque biology provide a potential mechanism for the beneficial effects of potent statins following ACS.
- © 2013 by American Heart Association, Inc.