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Association between serum levels of C-reactive protein and changes of plaque composition in non-infarct-related coronary arteries following high-intensity statin therapy. Results of the IBIS-4 Study

Session Understanding pathophysiology from imaging and functional assessment

Speaker Doctor Konstantinos Koskinas

Event : ESC Congress 2015

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Angiography, Invasive Imaging
  • Session type : Moderated Posters

Authors : KC Koskinas (Bern,CH), L Raeber (Bern,CH), M Taniwaki (Bern,CH), HM Garcia-Grcia (Rotterdam,NL), P Juni (Bern,CH), A Moschovitis (Bern,CH), CM Matter (Zurich,CH), S Zaugg (Bern,CH), S Windecker (Bern,CH)

K.C. Koskinas1 , L. Raeber1 , M. Taniwaki1 , H.M. Garcia-Grcia2 , P. Juni3 , A. Moschovitis1 , C.M. Matter4 , S. Zaugg1 , S. Windecker1 , 1Bern University Hospital, Cardiology - Bern - Switzerland , 2Cardialysis BV - Rotterdam - Netherlands , 3Institute of Social and Preventive Medicine - Bern - Switzerland , 4University Hospital Zurich, Cardiology - Zurich - Switzerland ,

Invasive and functional coronary imaging

European Heart Journal ( 2015 ) 36 ( Abstract Supplement ), 874

Background: Levels of serum inflammatory markers associate with changes of coronary plaque burden and composition in statin-treated patients with stable coronary artery disease. Acute myocardial infarction is triggered by inflammatory bursts that may precipitate plaque progression. The association between inflammatory markers and changes of coronary plaque burden and composition in patients with ST-elevation myocardial infarction (STEMI) is unknown.

Objectives: To asses volumetric and compositional changes of coronary atheroma in relation to serum lipoprotein and high-sensitivity C-reactive protein (hsCRP) levels in patients with STEMI treated with high-intensity statin therapy.

Methods: In the IBIS-4 study 82 patients with acute STEMI underwent serial intravascular ultrasound (IVUS) and radiofrequency (RF) IVUS of the two non-infarct related epicardial coronary arteries following successful primary percutaneous coronary intervention and repeated imaging after 13 months of treatment with rosuvastatin 40mg. All patients recruited at Bern University (n=44) with serial hsCRP measurement are included in the present analysis.

Results: At 13 months, LDL-C decreased by 38% to 77mg/dl, HDL increased by 13% to 48 mg/dl and hsCRP decreased by 58% to 0.70 mg/L. Regression of percent atheroma volume (−0.99%, 95% CI −1.84 to −0.14, p=0.024) did not correlate with levels of hsCRP and was accompanied by reduction of fibro-fatty tissue (p=0.005), increase of dense calcium (p=0.016) and no significant change of necrotic core tissue (p=0.22). Changes of RF-IVUS-defined components did not correlate with LDL-C or HDL-C levels. In contrast, on-treatment hsCRP correlated with the change of necrotic core tissue, which decreased in patients with the lowest hsCRP tertile (−0.13mm2, −0.23 to −0.04) and increased in patients across higher hsCRP tertiles (p=0.002). A per-lesion analysis showed lowest on-treatment hsCRP levels for thin-cap fibroatheromas (TCFAs) at baseline that progressed to non-TCFA lesions (0.03, 0.02 to 0.19 mg/L) and highest hsCRP levels for non-TCFA lesions that progressed to TCFAs at follow-up (1.75, 0.75 to 2.87 mg/L).

Conclusions: In this observationsl study of STEMI patients treated with high-intensity statin therapy, elevated on-treatment levels of hsCRP, but not of LDL-C, associated with serial increase of RF-IVUS-defined necrotic core. Increased levels of systemic inflammation may identify patients with progression of presumed high-risk indices of coronary plaque composition despite aggressive statin therapy. Larger studies are needed to determine potential prognostic implications of these associations.

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