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Lim JW, Jeong HS, Hong SJ, Kim HJ, Kim YC, Kang BG, Jeon SM, Cho JY, Lee SH, Joo HJ, Park JH, Yu CW. Effects of lowest-dose vs. highest-dose pitavastatin on coronary neointimal hyperplasia at 12-month follow-up in type 2 diabetic patients with non-ST elevation acute coronary syndrome: an optical coherence tomography analysis. Heart Vessels 2018; 34:62-73. [PMID: 30047013 DOI: 10.1007/s00380-018-1227-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 07/20/2018] [Indexed: 11/30/2022]
Abstract
Current ACC/AHA guidelines recommend high-dose statin therapy after coronary stenting, especially in diabetic patients; however, pitavastatin 4 mg or pitavastatin 1 mg are frequently used after coronary stenting in Asia, even in patients with acute coronary syndrome. We compared the effects of highest-dose and lowest-dose pitavastatin therapy on coronary neointimal hyperplasia at 12-month follow-up in diabetic patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) using optical coherence tomography. A total of 72 diabetic patients with NSTE-ACS were randomized to lowest-dose pitavastatin [1 mg (n = 36)] or highest-dose pitavastatin [4 mg (n = 36)] after everolimus-eluting stent implantation. The primary endpoint was to compare the normalized neointimal volume at 12-month follow-up. Normalized neointimal volume was significantly lower in the pitavastatin 4 mg group (4.00 ± 2.80 vs. 8.24 ± 2.83 mm3/mm, p < 0.01) at 12-month follow-up. There was also significant difference in neointimal area between the pitavastatin 4 mg group and pitavastatin 1 mg group (0.41 ± 0.28 vs. 0.74 ± 0.23 mm2, p < 0.01). Improvement of brachial artery flow-mediated dilation (baFMD) was significantly higher in the pitavastatin 4 mg group than in pitavastatin 1 mg group (0.15 ± 0.15 vs. - 0.03 ± 0.19 mm, p < 0.001). In addition, the improvement of adiponectin levels was significantly greater in the pitavastatin 4 mg group than in the pitavastatin 1 mg group (2.97 ± 3.98 vs. 0.59 ± 2.80 μg/mL, p < 0.05). Pitavastatin 4 mg significantly improved inflammatory cytokines and lipid profiles compared to pitavastatin 1 mg during the 12-month follow-up, contributing to the reduction of neointimal hyperplasia and to the improvement of baFMD in diabetic patients with NSTE-ACS requiring coronary stenting. Thus, the administration of pitavastatin 4 mg can be safely and effectively used in high-risk patients requiring coronary stenting. Trial registration NCT02545231 (Clinical Trial registration information: https://clinicaltrials.gov/ct2/show/NCT02545231 ).
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Affiliation(s)
- Jung Wook Lim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul, 136-705, Republic of Korea
| | - Han Saem Jeong
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul, 136-705, Republic of Korea
| | - Soon Jun Hong
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul, 136-705, Republic of Korea.
| | - Hyo Jeong Kim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul, 136-705, Republic of Korea
| | - Young Chan Kim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul, 136-705, Republic of Korea
| | - Bong Gyun Kang
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul, 136-705, Republic of Korea
| | - Su Min Jeon
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul, 136-705, Republic of Korea
| | - Jae Young Cho
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul, 136-705, Republic of Korea
| | - Seung Hoon Lee
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul, 136-705, Republic of Korea
| | - Hyung Joon Joo
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul, 136-705, Republic of Korea
| | - Jae Hyoung Park
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul, 136-705, Republic of Korea
| | - Cheol Woong Yu
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul, 136-705, Republic of Korea
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Yonetsu T, Kato K, Kim SJ, Xing L, Jia H, McNulty I, Lee H, Zhang S, Uemura S, Jang Y, Kang SJ, Park SJ, Lee S, Yu B, Kakuta T, Jang IK. Predictors for Neoatherosclerosis. Circ Cardiovasc Imaging 2012; 5:660-6. [DOI: 10.1161/circimaging.112.976167] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Recent studies have reported development of neoatherosclerosis (NA) inside the stents several years after stent implantation. The aim of this study was to determine the predictors for NA using optical coherence tomography.
Methods and Results—
From a total of 1080 patients who underwent optical coherence tomography, we identified 179 stents in 151 patients in which the mean neointimal thickness was >100 µm. The presence of lipid-laden neointima or calcification inside the stents was defined as NA in the present study. Patient characteristics, stent type, and time since stent implantation (stent age) were compared between stents with or without NA. Univariable and multivariable logistic regression analyses were used to assess the independent predictors. In univariate analysis, stent age ≥48 months (Odds ratio [OR], 4.48; [95% CI 2.68-9.65];
P
<0.001), drug-eluting stents (OR, 2.66; [95% CI, 1.38–5.16];
P
=0.004), age ≥65 years (OR, 1.91; [95% CI, 1.05–3.44];
P
=0.032), current smoking (OR, 2.30; [95% CI, 1.10–4.82];
P
=0.024), chronic kidney disease (OR, 4.17; [95% CI, 1.42–12.23];
P
=0.009), and angiotensin-converting enzyme inhibitors or angiotensin II receptor blockade use (OR, 0.42; [95% CI, 0.22–0.80];
P
=0.008) were significant predictors. In multivariate analysis, stent age ≥48 months, all subtypes of drug-eluting stent, current smoking, chronic kidney disease, and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockade use remained independent predictors for NA.
Conclusions—
In addition to the stent type and the stent age, patient characteristics, including current smoking, chronic kidney disease, and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockade, were associated with the presence of NA. This result may support the importance of secondary prevention after stent implantation.
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Affiliation(s)
- Taishi Yonetsu
- From the Cardiology Division (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.); Division of Cardiology, College of Medicine, Kyung Hee University, Seoul, Korea (S-J.K.); Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, Harbin, China (L.X., H.J., B
| | - Koji Kato
- From the Cardiology Division (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.); Division of Cardiology, College of Medicine, Kyung Hee University, Seoul, Korea (S-J.K.); Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, Harbin, China (L.X., H.J., B
| | - Soo-Joong Kim
- From the Cardiology Division (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.); Division of Cardiology, College of Medicine, Kyung Hee University, Seoul, Korea (S-J.K.); Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, Harbin, China (L.X., H.J., B
| | - Lei Xing
- From the Cardiology Division (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.); Division of Cardiology, College of Medicine, Kyung Hee University, Seoul, Korea (S-J.K.); Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, Harbin, China (L.X., H.J., B
| | - Haibo Jia
- From the Cardiology Division (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.); Division of Cardiology, College of Medicine, Kyung Hee University, Seoul, Korea (S-J.K.); Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, Harbin, China (L.X., H.J., B
| | - Iris McNulty
- From the Cardiology Division (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.); Division of Cardiology, College of Medicine, Kyung Hee University, Seoul, Korea (S-J.K.); Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, Harbin, China (L.X., H.J., B
| | - Hang Lee
- From the Cardiology Division (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.); Division of Cardiology, College of Medicine, Kyung Hee University, Seoul, Korea (S-J.K.); Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, Harbin, China (L.X., H.J., B
| | - Shaosong Zhang
- From the Cardiology Division (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.); Division of Cardiology, College of Medicine, Kyung Hee University, Seoul, Korea (S-J.K.); Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, Harbin, China (L.X., H.J., B
| | - Shiro Uemura
- From the Cardiology Division (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.); Division of Cardiology, College of Medicine, Kyung Hee University, Seoul, Korea (S-J.K.); Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, Harbin, China (L.X., H.J., B
| | - Yangsoo Jang
- From the Cardiology Division (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.); Division of Cardiology, College of Medicine, Kyung Hee University, Seoul, Korea (S-J.K.); Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, Harbin, China (L.X., H.J., B
| | - Soo-Jin Kang
- From the Cardiology Division (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.); Division of Cardiology, College of Medicine, Kyung Hee University, Seoul, Korea (S-J.K.); Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, Harbin, China (L.X., H.J., B
| | - Seung-Jung Park
- From the Cardiology Division (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.); Division of Cardiology, College of Medicine, Kyung Hee University, Seoul, Korea (S-J.K.); Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, Harbin, China (L.X., H.J., B
| | - Stephen Lee
- From the Cardiology Division (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.); Division of Cardiology, College of Medicine, Kyung Hee University, Seoul, Korea (S-J.K.); Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, Harbin, China (L.X., H.J., B
| | - Bo Yu
- From the Cardiology Division (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.); Division of Cardiology, College of Medicine, Kyung Hee University, Seoul, Korea (S-J.K.); Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, Harbin, China (L.X., H.J., B
| | - Tsunekazu Kakuta
- From the Cardiology Division (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.); Division of Cardiology, College of Medicine, Kyung Hee University, Seoul, Korea (S-J.K.); Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, Harbin, China (L.X., H.J., B
| | - Ik-Kyung Jang
- From the Cardiology Division (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA (T.Y., K.K., S-J.K., H.J., I.M., I-K.J.); Division of Cardiology, College of Medicine, Kyung Hee University, Seoul, Korea (S-J.K.); Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, Harbin, China (L.X., H.J., B
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