Author + information
- Received December 20, 2012
- Revision received March 20, 2013
- Accepted March 22, 2013
- Published online July 2, 2013.
- Annapoorna S. Kini, MD∗,
- Usman Baber, MD∗,
- Jason C. Kovacic, MD, PhD∗,
- Atul Limaye, MD∗,
- Ziad A. Ali, MD∗,
- Joseph Sweeny, MD∗,
- Akiko Maehara, MD†,
- Roxana Mehran, MD∗,†,
- George Dangas, MD, PhD∗,†,
- Gary S. Mintz, MD†,
- Valentin Fuster, MD, PhD∗,‡,
- Jagat Narula, MD, PhD∗,
- Samin K. Sharma, MD∗ and
- Pedro R. Moreno, MD∗∗ ()
- ∗Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Mount Sinai School of Medicine, New York, New York
- †Cardiovascular Research Foundation, New York, New York
- ‡Centro de Investigaciones Cardiovasculares CNIC, Madrid, Spain
- ↵∗Reprint requests and correspondence:
Dr. Pedro R. Moreno, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1030, New York, New York 10029.
Objectives This study sought to determine the impact of short-term intensive statin therapy on intracoronary plaque lipid content.
Background Statin therapy significantly reduces the risk for thrombotic events. Whether or not these benefits are attributable to reduction in plaque lipid content remains to be properly documented in human obstructive coronary artery disease (CAD).
Methods We randomized 87 patients with multivessel CAD undergoing percutaneous coronary intervention and at least 1 other severely obstructive (fractional flow reserve [FFR] ≤0.8) nontarget lesion (NTL) to intensive (rosuvastatin 40 mg daily) or standard-of-care lipid-lowering therapy. NTLs were evaluated at baseline and after 7 weeks of therapy with FFR, near-infrared spectroscopy, and intravascular ultrasound. The primary endpoint was the change in lipid-core burden index at the 4-mm maximal segment (LCBI4mm max), wherever this occurred within the lesion.
Results Upon follow-up, median reduction (95% confidence interval) in LCBI4mm max was significantly greater in the intensive versus standard group (−149.1 [−210.9 to −42.9] vs. 2.4 [−36.1 to 44.7]; p = 0.01). Results remained consistent after adjustment for baseline differences in LCBI between groups and use of change in LCBI across the entire lesion as the dependent outcome.
Conclusions Short-term intensive statin therapy may reduce lipid content in obstructive lesions. These hypothesis-generating findings warrant confirmation in larger studies with longer follow-up. (Reduction in YEllow Plaque by Aggressive Lipid LOWering Therapy [YELLOW]); NCT01567826)
Although there was no direct external funding provided for the YELLOW trial, all YELLOW trial participants were also enrolled in the COLOR registry, which was partially supported by InfraReDx, Inc. Dr. Kini has received research grant support from InfraReDx, Inc. Dr. Maehara has received research grants from Boston Scientific; and speaker fees from St. Jude Medical, Inc. Dr. Kovacic is supported by National Institutes of Health Grant K08HL111330; and has received research support from AstraZeneca. Dr. Mehran has received research grant support from The Medicines Company, Bristol-Myers Squibb, Sanofi-Aventis, Eli Lilly and Co., and Daiichi Sankyo, Inc. Dr. Mintz has received research support from and is a consultant to InfraReDx, Boston Scientific, and Volcano. Dr. Narula has received speaker fees from St. Jude Medical, Inc. Dr. Moreno is a founder and stockholder of InfraReDx, Inc., the company that produces the near-infrared catheter used in this study; and has received speaker fees from AstraZeneca. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 20, 2012.
- Revision received March 20, 2013.
- Accepted March 22, 2013.
- American College of Cardiology Foundation