IBIS-4: High-dose rosuvastatin reduced coronary atherosclerosis in STEMI patients

BARCELONA, Spain — One year of treatment with high-intensity rosuvastatin was associated with a significant reduction of coronary atherosclerosis, according to new study data.

The Integrated Biomarkers and Imaging Study, also known as IBIS-4, is a prospective cohort study nested into the COMFORTABLE-AMI trial, which compared biolimus-eluting stents vs. bare-metal stents in 1,161 patients with STEMI undergoing PCI.

At ESC Congress, Lorenz Räber, MD, reported data on 103 patients with STEMI enrolled in the intracoronary imaging study who underwent IVUS and radiofrequency ultrasonography of the two noninfarct-related epicardial coronary arteries after successful primary PCI. The data were collected from September 2009 to January 2011. Patients received high-intensity rosuvastatin (Crestor, AstraZeneca) 40 mg per day for 13 months plus serial intracoronary imaging. According to Räber, analysis of matched segments was available for 82 patients with 146 noninfarct-related epicaridal coronary arteries.

“Statins potently reduce cardiovascular events, and IVUS studies have shown that high-intensity statin therapy results in atheroma regression in stable CAD patients. Acute STEMI has not been included in IVUS regression studies despite the higher risk for recurrent events and high frequency of vulnerable plaques typically extending beyond the culprit lesion, and plaque phenotype is relevant in the pathogenesis of future events,” Räber, from the department of cardiology at Bern University Hospital, Switzerland, said during a press conference. “Therefore, it is of interest to study changes in plaque composition in response to high-intensity statin therapy.”

At 13 months, Räber reported a decrease in LDL from 3.29 mmol/L to 1.89 mmol/L and an increase in HDL from 1.1 mmol/L to 1.2 mmol/L (P<.001 for both).

The primary endpoint of change in percent atheroma volume of the noninfarct-related epicardial coronary arteries decreased by 0.9% (P=.007). About three-quarters of patients had regression in at least one noninfarct-related epicaridal coronary artery. During the study, percent necrotic core (P=.93) and number of radiofrequency ultrasonography-defined thin-cap fibroatheromas remained unchanged (124 vs. 116; P=.15).

“High-intensity statin therapy throughout 13 months is associated with a significant reduction of coronary atherosclerosis. High-intensity statin therapy did not change the proportion of necrotic core and plaque phenotypes,” Räber concluded. – by Katie Kalvaitis

For more information:

Räber L. Hot Line V. Coronary Artery Disease and Atrial Fibrillation. Presented at: the European Society of Cardiology Congress; Aug. 30-Sept. 3, 2014; Barcelona, Spain.

Räber L. Eur Heart J. 2014;doi:10.1093/eurheartj/ehu373.

Disclosure: Räber reports no relevant financial disclosures.