Changes in Plaque Lipid Content After Short-Term, Intensive Versus Standard Statin Therapy: The YELLOW Trial

May 02, 2013
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Authors:
Kini AS, Baber U, Kovacic JC, et al.
Citation:
J Am Coll Cardiol 2013;May 1:[Epub ahead of print].
Summary By:
Debabrata Mukherjee, MD, FACC

Study Questions:

What is the impact of intensive statin therapy on the lipid content and flow physiology in patients with severely obstructive lesions?

Methods:

After preliminary evaluation of 779 patients, the investigators randomized 87 patients with multivessel coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI), and at least one 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 (IVUS). The primary endpoint was the change in lipid-core burden index at the 4 mm max segment (LCBI4mm max), wherever this occurred within the lesion, and was analyzed by analysis of covariance (ANCOVA) performed on rank transformed data with the baseline value as a covariate.

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, -42.9] vs. 2.4 [-36.1, 44.7]; p = 0.01). LCBI at the lesion was also reduced in the intensive group, from 132.4 (99.0, 201.2) at baseline to 99.8 (64.2, 159.3) at follow-up (p = 0.02). However, the standard group showed no significant changes after therapy.

Conclusions:

The authors concluded that short-term, intensive statin therapy may reduce lipid content in obstructive lesions.

Perspective:

This prospective, short-term, randomized YELLOW trial quantified the effects of rosuvastatin to reduce lipid content in severely obstructive coronary lesions compared to standard therapy. The median percent reductions in LCBI4mm max in the intensive therapy and standard groups were 32.2% and 0.6%, respectively. Overall, it appears that short-term, intensive statin therapy reduces lipid content in obstructive lesions, but the small sample size and large baseline imbalances observed in this study may reduce the reliability of these findings. These results should be viewed as preliminary rather than definitive, and need confirmation in larger studies with longer follow-up.

Keywords: Fluorobenzenes, Coronary Artery Disease, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Pyrimidines, Sulfonamides, Percutaneous Coronary Intervention


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