Log in to MyACC
Atheroma Regression in Response to Lipid-Lowering Therapy
Quick Takes
- Concomitant favorable changes in coronary atheroma burden and composition occurred in one third of patients with AMI treated with very potent lipid-lowering therapy and was associated with favorable cardiovascular outcomes at 1 year.
- Of note, the occurrence of triple regression was independently associated with alirocumab therapy (most likely a PCSK9 inhibitor class effect) and greater baseline lipid accumulation.
- Additional studies are indicated to investigate the effects of triple regression on hard cardiovascular events.
Study Questions:
What are the rates, determinants, and prognostic implications of triple regression in patients presenting with acute myocardial infarction (AMI) and treated with high-intensity lipid-lowering therapy?
Methods:
The investigators conducted the PACMAN-AMI trial, which employed serial intravascular ultrasound, near-infrared spectroscopy, and optical coherence tomography to compare the effects of alirocumab versus placebo in patients receiving high-intensity statin therapy. Triple regression was defined by the combined presence of percent atheroma volume reduction, maximum lipid core burden index within 4 mm (maxLCBI4mm) reduction, and minimal fibrous cap thickness increase. Clinical outcomes at 1-year follow-up were assessed. A multivariable logistic regression analysis including relevant clinical characteristics (age, sex, diabetes, and prior MI) was used to investigate the adjusted odds ratio (OR) (95% confidence interval [CI]) of triple regression for the composite endpoint.
Results:
Overall, 84 (31.7%) patients showed triple regression (40.8% in the alirocumab group vs. 23.0% in the placebo group, p = 0.002). On-treatment low-density lipoprotein cholesterol levels were lower in patients with versus without triple regression (between-group difference, -27.1 [-37.7 to -16.6] mg/dL; p < 0.001). Triple regression was independently predicted by alirocumab treatment (OR, 2.83; 95% CI, 1.57-5.16; p = 0.001) and a higher baseline maxLCBI4mm (OR, 1.03; 95% CI, 1.01-1.06; p = 0.013). The composite clinical endpoint of death, MI, and ischemia-driven revascularization occurred less frequently in patients with versus without triple regression (8.3% vs. 18.2%, p = 0.04).
Conclusions:
The authors report that triple regression occurred in one third of AMI patients receiving high-intensity lipid-lowering therapy and was associated with alirocumab treatment, higher baseline lipid content, and reduced cardiovascular events.
Perspective:
This post hoc subanalysis of the PACMAN-AMI trial reports that concomitant favorable changes in coronary atheroma burden and composition occurred in one third of patients with AMI treated with very potent lipid-lowering therapy and was associated with favorable cardiovascular outcomes at 1 year, primarily driven by reduction in ischemia-driven revascularization events. Of note, the occurrence of triple regression was independently associated with alirocumab therapy (most likely a proprotein convertase subtilisin/kexin type 9 [PCSK9] inhibitor class effect) and greater baseline lipid accumulation. Additional studies are indicated to investigate the effects of triple regression on hard cardiovascular events.
Clinical Topics: Acute Coronary Syndromes, Dyslipidemia, Lipid Metabolism
Keywords: Acute Coronary Syndrome, Lipids
< Back to Listings
