Icosapent ethyl positively impacts coronary physiology on FFR-CT
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Key takeaways:
- Statin-treated patients with CAD and high triglycerides had positive impacts on coronary physiology with icosapent ethyl vs. placebo.
- The study suggests FFR-CT can be a way to assess the effect of CV drugs.
In statin-treated patients with CAD and elevated triglycerides, icosapent ethyl benefited coronary physiology as assessed by CT-derived fractional flow reserve compared with placebo, according to new data from the EVAPORATE trial.
As Healio previously reported, in the main results of EVAPORATE, patients assigned icosapent ethyl (Vascepa, Amarin) had reductions in multiple plaque components at 18 months compared with those assigned placebo. New data derived from FFR-CT (HeartFlow) on 47 patients (mean age, 57 years; 51% men) from EVAPORATE with 507 coronary lesions were published in European Heart Journal – Cardiovascular Imaging.
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“Icosapent ethyl has been shown to significantly reduce the burden of first, subsequent and total ischemic events among statin-treated patients with cardiovascular disease or diabetes and elevated triglycerides in REDUCE-IT,” Mark G. Rabbat, MD, FACC, FAHA, professor of radiology and medicine and director of cardiac CT at Loyola University Chicago, told Healio. “However, the mechanisms driving this marked clinical benefit are not fully known. No study to date has assessed the impact of icosapent ethyl on coronary physiology.”
The primary endpoint was change in FFR-CT value between baseline, 9 months and 18 months in the distal coronary segment of the most diseased vessel.
At baseline, FFR-CT values were similar between the groups (icosapent ethyl, 0.83; placebo, 0.84; P = .55), according to the researchers.
Compared with placebo, icosapent ethyl improved the primary endpoint at 9 months (0.01 vs. –0.05; P = .02) and 18 months (–0.01 vs. –0.09; P = .03), Rabbat and colleagues found.
“This early and sustained improvement in FFR-CT at 9-month and 18-month follow-up provides mechanistic insight into the clinical benefits observed in the REDUCE-IT trial,” Rabbat told Healio. “Patients with established cardiovascular disease or diabetes and a fasting triglyceride level of greater than 135 mg/dL on statin therapy may be a good candidate for icosapent ethyl.”
The outcome of change in translesional FFR-CT across the most severe coronary lesion per vessel at 18 months numerically favored the icosapent ethyl group (–0.06 vs. –0.09; P = .054), according to the researchers.
“This is the first study to assess drug effect using FFR-CT and paves the way for future pharmaceuticals to use FFR-CT to assess treatment response and drug efficacy,” Rabbat told Healio.
For more information:
Mark G. Rabbat, MD, FACC, FAHA, can be reached at mrabbat@lumc.edu; Twitter: @mgrabbatmd.
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