新規心血管イベント発症及び冠動脈プラークの進展・退縮におけるHMG-CoA還元酵素阻害剤(スタチン)の果たす役割 : 3次元血管内超音波(3D-IVUS)を用いた検討

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Background : HMG-CoA reductase inhibitor (statin) reduces cardiac events, and recent clinical trials have reported that statin retards the progression of coronary atherosclerotic plaque. However, it is not fully understood whether the regression of coronary atherosclerotic plaque by statin therapy affects new cardiovascular events. We investigated the effect of statins on the progression-regression of coronary atherosclerotic plaque and new cardiovascular events. Methods : We examined 403 patients undergoing intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI) for the treatment of coronary artery disease (CAD). All patients were assigned to the statin group (187 patients) or the non-statin group (216 patients). The following cardiovascular events were selected as the clinical end-points : myocardial infarction, death, coronary artery bypass graft, and PCI for new lesion. Of 403 patients, 165 underwent volumetric IVUS analyses at baseline and at average 10-month follow-up in the matched left main trunk. Results : Although baseline clinical characteristics were similar between the 2 groups, LDL-cholesterol levels in the statin group were significantly lower than those in the non-statin group (108±25 mg/dl vs. 125±26mg/dl, p<0.001). In long-term clinical events, the incidence of PCI for new lesions was significantly lower in the statin group than that in the non-statin group (10.1% vs. 26.4%, p<0.001). In serial volumetric IVUS analyses, there were no differences in volume index at baseline between the 2 groups. However, plaque volume index (PVI) was significantly reduced in the statin group (5.4±15.7% decrease) compared with the non-statin group (9.5±15.7% increase, p<0.001) at follow-up. There was a positive correlation between % change in LDL-C level and % change in PVI. Conclusion : Statin therapy significantly induced coronary atherosclerotic plaque regression associated with a significant reduction of LDL-C level in the short-term. These results suggest that statin therapy prevents the incidence of new cardiovascular events including for new lesions in patients with CAD in the long-term.
愛知医科大学の論文
2006-12-15

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