Effects of statins on plaque rupture assessed by optical coherence tomography in patients presenting with acute coronary syndromes: insights from the optical coherence tomography (OCT)-FORMIDABLE registry
Year: 2017
Type: article
Study design: Observational Study
Abstract: Aims: Chronic pre-treatment with statins may reduce mortality and morbidity in patients experiencing acute coronary syndromes (ACS), but mechanisms accounting for these findings are not completely understood. Methods and results: The optical coherence tomography (OCT)-Formidable registry retrospectively enrolled 285 consecutive patients with ACS undergoing OCT in 9 European centres. Mean age was 60.4 ± 12.8 years, 148 (51.9%) patients had hyperlipemia, 45 (15.8%) diabetes mellitus and 142 (49.8%) presented with ST Segment Elevation Myocardial Infarction (STEMI). Patients were stratified according to statin prescription: 150 (52.6%) were on chronic pre-treatment with statins before ACS and were more likely to present with non-ST segment elevation acute coronary syndromes (NSTE-ACS) at admission (111, 74%) rather than STEMI, while the opposite was observed for patients not on statins. The primary end-point of ruptured plaque at OCT occurred significantly less frequently in the patients on chronic pre-treatment with statins [odds ratio (OR) 0.375, 95% confidence interval (CI) 0.185-0.759, P = 0.006]. The secondary end-point of thin-cap fibro-atheroma (TCFA) at any site was significantly less frequent in the statin group (OR 0.423, 95%CI 0.213-0.840, P = 0.014). No differences were observed for the secondary end-point of not-ruptured TCFA as the culprit lesion. Pre-specified sensitivity analysis was conducted according to the pattern of ACS: the reported differences were confirmed for NSTE-ACS patients, with a trend towards less plaque rupture and a significant reduction of TCFA at any site with statins, but not for STEMI. Conclusions: Chronic pre-treatment with statins is associated with a reduced prevalence of ruptured plaques in patients presenting with ACS, particularly in those with NSTE-ACS. Statins bear hence the potential to reduce morbidity during the acute phase of ACS.
DOI: 10.1093/ehjci/jex102
Authors: Sebastiano Gili, Mario Iannaccone, Francesco Colombo, Antonio Montefusco, Nicolas Amabile, Simone Calcagno, Davide Capodanno, Giancarla Scalone, Andrea Rognoni, Pierluigi Omedè, Fabrizio Ugo, Erika Cavallo, Massimo Mancone, Andrea Mangiameli, Giacomo Boccuzzi, Joshua Hiansen, Pascal Motreff, Konstantinos Toutouzas, Roberto Garbo, Gennaro Sardella, Corrado Tamburino, Maurizio D’Amico, Claudio Moretti, Christian Templin, Fiorenzo Gaita, Geraud Souteyrand, Giampaolo Niccoli, Fabrizio D’Ascenzo
Institutions: University of Zurich, University Hospital Zurich, University of Turin, Ospedale San Giovanni Bosco, Institute Mutualiste Montsouris, Sapienza University of Rome, University of Catania, Ferrarotto Hospital, Università Cattolica del Sacro Cuore, Azienda Ospedaliero Universitaria Maggiore della Carita, Toronto General Hospital, Centre National de la Recherche Scientifique, Centre Hospitalier Universitaire de Clermont-Ferrand, Hippocration General Hospital
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2621531045