Abstract 14740: Impact of Statin-Ezetimibe Combination on Coronary Atheroma Progression/Regression in Patients With and Without Chronic Kidney Disease - Subanalysis of PRECISE-IVUS Trial
Background: Chronic kidney disease (CKD) deteriorate the prognosis of patients undergoing percutaneous coronary intervention (PCI). Because coronary artery disease (CAD) is the major cause of death in patients with CKD, cardiovascular risk reduction has been clinically important even in CKD patients.
Hypothesis: We hypothesized that the aggressive lipid-lowering with statin/ezetimibe attenuated coronary atherosclerotic development even in patients with CKD.
Methods: In the prospective, randomized, controlled, multicenter PRECISE-IVUS trial, 246 patients undergoing intravascular ultrasound (IVUS)-guided PCI were randomized to atorvastatin/ezetimibe combination or atorvastatin alone to evaluate the coronary antiatherosclerotic effect by the aggressive lipid-lowering. (The dosage of atorva was uptitrated with a treatment goal of lowering low-density lipoprotein cholesterol (LDL-C) below 70mg/dL.) Serial volumetric IVUS findings obtained at baseline and 9–12 months follow-up to quantify the coronary plaque response in 202 patients, were compared stratified by the presence or absence of CKD.
Results: CKD was observed in 52 patients (26%) among 202 enrolled patients. Compared with non-CKD group, CKD group was significantly older (71.5±8.6yrs vs. 64.4±9.6yrs, p<0.001) with similar prevalence of comorbid coronary risk factors. In addition, baseline lipid profiles and cholesterol synthesis/absorption parameters were also comparable between the groups. Aggressive lipid-lowering regressed the delta percent atheroma volume (ΔPAV) not only in patients without CKD but also with CKD (-0.9 [-2.4 to 0.4]% vs. -1.1 [-3.5 to 0.1]%, p=0.8). Similar to the non-CKD group (-1.4 [-2.8 to -0.1]% vs. -0.2 [-1.7 to 1.0]%, p=0.002), the atorvastatin/ezetimibe combination showed the significantly stronger reduction in ΔPAV, compared with atorvastatin alone even in CKD group (-2.6 [-5.6 to -0.4]% vs. -0.9 [-2.4 to 0.2]%, p=0.04).
Conclusion: As with non-CKD, aggressive lipid-lowering with atorvastatin/ezetimibe demonstrated stronger coronary plaque regression effect even in patients with CKD compared with atorvastatin monotherapy.
Author Disclosures: S. Nagamatsu: None. K. Tsujita: None. K. Yamanaga: None. S. Sugiyama: None. H. Shimomura: None. T. Yamashita: None. K. Sakamoto: None. K. Nakao: None. S. Nakamura: None. M. Ishihara: None. K. Matsui: None. N. Yamamoto: None. S. Koide: None. T. Matsumura: None. K. Fujimoto: None. R. Tsunoda: None. Y. Morikami: None. K. Matsuyama: None. S. Oshima: None. K. Kaikita: None. S. Hokimoto: None. H. Ogawa: Other Research Support; Modest; Eisai Co.,Ltd.. Other Research Support; Significant; Abbott Vascular Jaoan, Bayer Yakuhin, Ltd., Boehringer Ingelheim Japan, Boston Scientific Japan K.K., Chugai Pharmaceutical Co.,Ltd., Daiichi Sankyo Co., Ltd., Dainippon Sumitomo Pharma Co., Ltd., Fukuda Denshi Co., Ltd., Johnson & Johnson, Medtronic Japan Co., Ltd., Mitsubishi Tanabe Pharma, Mochida Pharmaceutical Co., Ltd., Nihon Kohden, Novartis Pharma K.K., Ono Pharmaceutical Co., Ltd., Otsuka Pharmaceutical Co, Ltd, Sanofi K.K., Takeda Pharmaceutical Co., Ltd., Teijin, Teijin Pharma Co., Ltd, Terumo. Honoraria; Modest; AstraZeneca K.K., Eisai Co.,Ltd., Otsuka Pharmaceutical Co, Ltd, Takeda Pharmaceutical Co., Ltd., Teijin Pharma Co., Ltd. Honoraria; Significant; Bayer Yakuhin, Ltd., Daiichi Sankyo Co., Ltd., MSD K.K..
- © 2016 by American Heart Association, Inc.