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Statin and aspirin therapy are mainstay treatments in patients with coronary artery disease (CAD). Atorvastatin and rosuvastatin are wildly used in clinical treatment. Optical coherence tomography (OCT) and intravascular ultrasound (IVUS) can qualitatively and quantitatively evaluate fibrous cap thickness(FCT), plaque volume and total atheroma burden. Combining OCT with IVUS will allow comprehensive assessment of microscopic and macroscopic plaque response to statin therapy.
The current study was designed to investigate the effect of atorvastatin 20mg and rosuvastatin 10mg on the changes of FCT measured by OCT and percent atheroma volume (PAV) by IVUS in patients with coronary artery disease.
OCT was used to assess FCT and lipid arc and IVUS to assess PAV at baseline and at 12months. All OCT images were analyzed using the previously validated criteria for plaque characterization. At baseline, FCT of lipid plaque was measured at its thinnest part 3 times, and the average value was calculated. At follow-up, FCT was measured at the same site as it was measured at baseline using the same method. Lipid arc was measured on the cross-section with largest lipid pool. All IVUS images were performed using a software program. PAV was determined in accordance with the standards of the American College of Cardiology.
Thirty-one lipid-rich plaques in 25 patients with rosuvastatin10mg and 30 lipid-rich plaques in 19 patients with atorvastatin 20mg were enrolled in the present study. In both groups, lipid profiles were significantly improved at 12 months (low-density lipoprotein cholesterol: -34.6±35.0mg/dl vs. -23.2±32.7 mg/dl, p=0.283; total cholesterol:-50.1±41.4mg/dl vs. -37.0±41.9 mg/dl, p=0.318). At baseline, FCT, maximum lipid arc, and PAV were comparable between the 2 groups (p=0.899, p=0.807, and p=0.420, respectively). At 12 months, the rosuvastatin 10mg group had significantly thicker fibrous cap compared with the atorvastatin 20mg group(110±67.9μm vs. 66.2±67.3μm, p=0.016). At 12-month follow-up, the absolute change in lipid arc from baseline was comparable in atorvastatin 20mg group compared with rosuvastatin10mg group (-29.8±54.3° vs. -40.0±56.4°, p=0.467). At baseline, the absolute change in PAV was also comparable between the 2 groups(0.11±4.06% vs. -0.75±4.63%, p=0.461).
The administration of atorvastatin 20mg or rosuvastatin 10mg in patients with coronary artery disease equivalently resulted in significant regression of lipid arc and change of PAC, but the fibrous cap became thicker inrosuvastatin 10 mg group.