Effect of High-Intensity Statin Therapy on Atherosclerosis in Non-Infarct-Related Coronary Arteries (IBIS-4): A Serial Intravascular Ultrasonography Study

Study Questions:

What is the impact of high-intensity statin therapy on plaque burden, composition, and phenotype in non–infarct-related arteries of ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI)?


Between September 2009 and January 2011, 103 STEMI patients underwent intravascular ultrasonography (IVUS) and radiofrequency ultrasonography (RF-IVUS) of the two non–infarct-related epicardial coronary arteries (non-IRA) after successful primary PCI. Patients with either non-IRA with >50% stenosis were excluded. Patients were treated with rosuvastatin 40 mg/day throughout 13 months, and serial intracoronary imaging with the analysis of matched segments was available for 82 patients with 146 non-IRAs. The primary IVUS endpoint was the change in percent atheroma volume (PAV).


After 13 months, low-density lipoprotein cholesterol (LDL-C) had decreased from a median of 127 to 73 mg/dl (p < 0.001), and high-density lipoprotein cholesterol (HDL-C) levels had increased from 42.6 to 46.4 mg/dl (p < 0.001). PAV of the non-IRA decreased by 20.9% (95% confidence interval [CI], 21.56-20.25; p = 0.007). Patients with regression in at least one non-IRA were more common (74%) than those without (26%). Percent necrotic core remained unchanged (20.05%; 95% CI, 21.05-0.96%; p = 0.93), as did the number of RF-IVUS defined thin-cap fibroatheromas (124 vs. 116, p = 0.15).


High-intensity rosuvastatin therapy over 13 months is associated with regression of coronary atherosclerosis in non-IRAs without changes in RF-IVUS defined necrotic core or plaque phenotype among STEMI patients.


Interestingly, the greater reduction in LDL-C and increase in HDL-C over 13 months resulted in larger PAV reduction, which was not the case for baseline LDL-C and HDL-C. The failure to reduce the size of the necrotic core and fibroatheroma characteristics was a surprise that may be related to the relatively short follow-up. As in other statin studies, there was an increase in calcium content, which may be a signal of healing and formation of more stable plaques.

Clinical Topics: Dyslipidemia, Noninvasive Imaging, Atherosclerotic Disease (CAD/PAD), Lipid Metabolism, Nonstatins, Statins, Echocardiography/Ultrasound

Keywords: Fluorobenzenes, Cholesterol, Coronary Artery Disease, Atherosclerosis, Plaque, Atherosclerotic, Pyrimidines, Constriction, Pathologic, Ultrasonography, Interventional, Sulfonamides, Calcium, ESC Congress

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