Author + information
- Yang Cao1,
- Gary Mintz2,
- Mitsuaki Matsumura3,
- W.E.N.B.I.N. ZHANG4,
- Cheolmin Lee5,
- Tsunekazu Kakuta6 and
- Akiko Maehara7
- 1The first affiliated hospital of Harbin Medical University, New York, New York, United States
- 2Cardiovascular Research Foundation, Washington, District of Columbia, United States
- 3Cardiovascular Research Foundation, New York, New York, United States
- 4SIR RUN RUN SHAW Hospital, Elmhurst, New York, United States
- 5Cardiovascular Research Foundation, New York, United States
- 6Unknown, Tsuchiura, Japan
- 7Cardiovascular Research Foundation, New York, New York, United States
We sought to investigate the association between serum LDL cholesterol, statin use, plaque vulnerability, and lipid composition using both optical coherence tomography (OCT) and intravascular ultrasound (IVUS).
We retrospectively analyzed 805 pts with CAD (38.9% acute coronary syndromes [ACS]) who underwent coronary intervention. IVUS plaque burden (plaque/vessel) was assessed at the minimum lumen area site; volume indices (mean angle × length) of lipids, macrophages, calcium, and fibrous cap thickness by OCT were measured for the entire lesion. Pts were divided into tertiles stratified by LDL and compared.
The median pt age was 66 years with 82.0% men, 34.4% with diabetes, and 53.4% with no pre-admission statins. Median lesion length was 22.6 mm, and 30.5% had a thin-cap fibroatheroma. Macrophage and lipid volume indices and plaque burden were greatest in the high LDL tertile and lowest in the low LDL tertile; calcium volume index was the lowest and the fibrous cap was the thinnest in the high LDL tertile. Value of p for trend <0.05 in all plaque morphology parameters in different LDL group. In the multivariable linear regression model (Table, all p<0.05), after adjusting for clinical risk factors (age, sex, smoking, diabetes, renal insufficiency, ACS, and statin use), LDL was independently associated with the morphological findings. Statin use pre-admission was independently associated with fibrous cap thickness and lipid volume index.
|Independent variable||LDL Tertile||Multivariate Linear Analysis Regression Coefficient|
|Low (78 mg/dL [66-86]) (n=265)||Intermediate (107 mg/dL [99-115]) (n=267)||High (142 mg/dL [130-157]) (n=273)||LDL||Statin use|
|Fibrous cap thickness (μm)||90 (60-130)||83 (60-120)||70 (60-120)||—||10.2 (1.1 to 19.3)|
|Macrophage volume index (degree*mm)||322 (141-557)||365 (149-583)||383 (199-666)||1.0 (0.2 to 1.7)||—|
|Lipid volume index (degree*mm)||1157 (496-1893)||1329 (649-2156)||1582 (959-2477)||5.3 (2.8 to 7.7)||-207 (-387 to -27)|
|Calcification volume index (degree*mm)||285 (30-838)||180 (41-724)||122 (0-482)||-2.5 (-4.5 to -0.6)||—|
|IVUS Plaque burden (%)||83.2 (77.6-87.8)||85.4 (79.9-89.1)||85.9 (81.7-89.1)||0.02 (0.005 to 0.035)||—|
OCT-assessed plaque vulnerability was associated with LDL levels irrespective of statin treatment.