Effect of combination of ezetimibe and a statin on coronary plaque regression in patients with acute coronary syndrome

Naohisa Nakajima, Katsumi Miyauchi, Takayuki Yokoyama, Manabu Ogita, Tadashi Miyazaki, Hiroshi Tamura, Akihisa Nishino, Ken Yokoyama, Sinya Okazaki, Takeshi Kurata, Satoru Suwa, Hiroyuki Daida
2014 International Journal of Cardiology Metabolic & Endocrine  
Background: Many trials have shown that statins can reduce plaque volume (PV) associated with the degree of LDL-C reduction. The goal of this study is to determine whether the combination of ezetimibe and a statin produces greater reductions in coronary plaque volume compared to statin monotherapy in patients with acute coronary syndrome (ACS). Methods: Prospective serial intravascular ultrasound (IVUS) of non-culprit lesions of the target vessel was performed in 95 patients with ACS. Of these,
more » ... 50 patients were administered combination of atorvastatin 20 mg/day and ezetimibe 10 mg/day. 45 subjects treated by atorvastatin 20 mg/day alone were the control group. At the beginning and 24 weeks after PCI, quantitative PV was accessed by IVUS. The primary end point was the percentage change in non-culprit coronary PV. Results: LDL-C was significantly decreased by 49.8% in the ezetimibe/atorvastatin group compared with 34.6% in the atorvastatin group. Significant regression of plaque volume was observed from baseline to follow-up in both groups. The percentage changes in PV were greater in the ezetimibe/atorvastatin group than in the atorvastatin alone group (12.5% versus 7.6%, p = 0.06), but statistically not significant. In 34 diabetic patients, regression of PV was significantly greater in the ezetimibe/atorvastatin group than in the statin alone group (13.9% versus 5.1%, p = 0.04) and % change of PV significantly correlated with LDL-C reduction. Conclusions: Additional LDL-C reduction with combination therapy tended to reduce more plaque regression compared to a statin alone in patients with ACS. In diabetic patients, further reduction of LDL-C was associated with a significantly greater reduction in PV.
doi:10.1016/j.ijcme.2014.03.001 fatcat:hkgsyo7janah5m6er4meb7hpp4