This Article Free upon publication Full Text Full Text (PDF) All Versions of this Article: 110/9/1061    most recent 01.CIR.0000140261.58966.A4v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Okazaki, S. Articles by Daida, H. Search for Related Content PubMed PubMed Citation Articles by Okazaki, S. Articles by Daida, H. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB ACETYLSALICYLIC ACID ATORVASTATIN HEPARIN HEPTANOIC ACID PYRROLE Related Collections Cardiovascular Pharmacology Risk Factors Imaging Acute coronary syndromes

(Circulation. 2004;110:1061-1068.)
© 2004 American Heart Association, Inc.

Original Articles

Early Statin Treatment in Patients With Acute Coronary Syndrome

Demonstration of the Beneficial Effect on Atherosclerotic Lesions by Serial Volumetric Intravascular Ultrasound Analysis During Half a Year After Coronary Event: The ESTABLISH Study

Shinya Okazaki, MD; Takayuki Yokoyama, MD; Katsumi Miyauchi, MD; Kazunori Shimada, MD; Takeshi Kurata, MD; Hitoshi Sato, MD; Hiroyuki Daida, MD

From the Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan.

Correspondence to Shinya Okazaki, MD, Department of Cardiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku Tokyo 113-8421 Japan. E-mail shinya{at}med.juntendo.ac.jp

Received February 10, 2004; revision received May 6, 2004; accepted May 18, 2004.

Background— Recent clinical trials have demonstrated that aggressive lipid lowering by statins could prevent recurrent events after acute coronary syndrome (ACS). We hypothesized that this efficacy was caused by a significant reduction in plaque volume by aggressive LDL cholesterol (LCL-C) lowering. The present study investigated the effect of early statin treatment on plaque volume of a nonculprit lesion by serial volumetric intravascular ultrasound in patients with ACS.

Methods and Results— Seventy patients with ACS were enrolled. All patients underwent emergency coronary angiography and percutaneous coronary intervention (PCI). They were randomized to intensive lipid-lowering therapy (n=35; atorvastatin 20 mg/d) or control (n=35) groups after PCI. Volumetric intravascular ultrasound analyses were performed at baseline and 6-month follow-up for a non-PCI site in 48 patients (atorvastatin, n=24; control, n=24). LDL-C level was significantly decreased by 41.7% in the atorvastatin group compared with the control group, in which LDL-C was increased by 0.7% (P<0.0001). Plaque volume was significantly reduced in the atorvastatin group (13.1±12.8% decrease) compared with the control group (8.7±14.9% increase; P<0.0001). Percent change in plaque volume showed a significant positive correlation with follow-up LDL-C level (R=0.456, P=0.0011) and percent LDL-C reduction (R=0.612, P<0.0001), even in patients with baseline LDL-C <125 mg/dL.

Conclusions— Early aggressive lipid-lowering therapy by atorvastatin for 6 months significantly reduced the plaque volume in patients with ACS. Percent change in plaque volume showed a significant positive correlation with percent LDL-C reduction, even in patients with low baseline LDL-C.

Key Words: atherosclerosis • lipids • plaque • statins • coronary disease

This article has been cited by other articles:

				J. J.P. Kastelein and E. de Groot Ultrasound imaging techniques for the evaluation of cardiovascular therapies Eur. Heart J., April 1, 2008; 29(7): 849 - 858. [Abstract] [Full Text] [PDF]

				J. Aoki, G. S. Mintz, N. J. Weissman, J. T. Mann, L. Cannon, J. Greenberg, E. Grube, A.R. Z. Masud, J. Koglin, L. Mandinov, et al. Chronic Arterial Responses to Overlapping Paclitaxel-Eluting Stents: Insights From Serial Intravascular Ultrasound Analyses in the TAXUS-V and -VI Trials J. Am. Coll. Cardiol. Intv., April 1, 2008; 1(2): 161 - 167. [Abstract] [Full Text] [PDF]

				T. Kubo, T. Imanishi, S. Takarada, A. Kuroi, S. Ueno, T. Yamano, T. Tanimoto, Y. Matsuo, T. Masho, H. Kitabata, et al. Assessment of Culprit Lesion Morphology in Acute Myocardial Infarction: Ability of Optical Coherence Tomography Compared With Intravascular Ultrasound and Coronary Angioscopy J. Am. Coll. Cardiol., September 4, 2007; 50(10): 933 - 939. [Abstract] [Full Text] [PDF]

				J. Afilalo, A. A Majdan, and M. J Eisenberg Intensive statin therapy in acute coronary syndromes and stable coronary heart disease: a comparative meta-analysis of randomised controlled trials Heart, August 1, 2007; 93(8): 914 - 921. [Abstract] [Full Text] [PDF]

				S. J. Nicholls, E. M. Tuzcu, I. Sipahi, A. W. Grasso, P. Schoenhagen, T. Hu, K. Wolski, T. Crowe, M. Y. Desai, S. L. Hazen, et al. Statins, High-Density Lipoprotein Cholesterol, and Regression of Coronary Atherosclerosis JAMA, February 7, 2007; 297(5): 499 - 508. [Abstract] [Full Text] [PDF]

				L. W. Klein Atherosclerosis Regression, Vascular Remodeling, and Plaque Stabilization J. Am. Coll. Cardiol., November 8, 2006; (2006) j.jacc.2006.10.039v1. [Full Text] [PDF]

				E. Hulten, J. L. Jackson, K. Douglas, S. George, and T. C. Villines The Effect of Early, Intensive Statin Therapy on Acute Coronary Syndrome: A Meta-analysis of Randomized Controlled Trials. Arch Intern Med, September 25, 2006; 166(17): 1814 - 1821. [Abstract] [Full Text] [PDF]

				H. Yokoyama, N. Katakami, and Y. Yamasaki Recent Advances of Intervention to Inhibit Progression of Carotid Intima-Media Thickness in Patients With Type 2 Diabetes Mellitus Stroke, September 1, 2006; 37(9): 2420 - 2427. [Abstract] [Full Text] [PDF]

				J. R. Crouse III Thematic review series: Patient-Oriented Research. Imaging atherosclerosis: state of the art J. Lipid Res., August 1, 2006; 47(8): 1677 - 1699. [Abstract] [Full Text] [PDF]

				S. J. Nicholls, E. M. Tuzcu, I. Sipahi, P. Schoenhagen, and S. E. Nissen Intravascular Ultrasound in Cardiovascular Medicine Circulation, July 25, 2006; 114(4): e55 - e59. [Full Text] [PDF]

				M. Briel, G. G. Schwartz, P. L. Thompson, J. A. de Lemos, M. A. Blazing, G.-A. van Es, M. Kayikcioglu, H.-R. Arntz, F. R. den Hartog, N. J. G. M. Veeger, et al. Effects of early treatment with statins on short-term clinical outcomes in acute coronary syndromes: a meta-analysis of randomized controlled trials. JAMA, May 3, 2006; 295(17): 2046 - 2056. [Abstract] [Full Text] [PDF]

				S. E. Nissen, S. J. Nicholls, I. Sipahi, P. Libby, J. S. Raichlen, C. M. Ballantyne, J. Davignon, R. Erbel, J. C. Fruchart, J.-C. Tardif, et al. Effect of Very High-Intensity Statin Therapy on Regression of Coronary Atherosclerosis: The ASTEROID Trial JAMA, April 5, 2006; 295(13): 1556 - 1565. [Abstract] [Full Text] [PDF]

				C. A.G. Van Mieghem, E. P. McFadden, P. J. de Feyter, N. Bruining, J. A. Schaar, N. R. Mollet, F. Cademartiri, D. Goedhart, S. de Winter, G. R. Granillo, et al. Noninvasive Detection of Subclinical Coronary Atherosclerosis Coupled With Assessment of Changes in Plaque Characteristics Using Novel Invasive Imaging Modalities: The Integrated Biomarker and Imaging Study (IBIS) J. Am. Coll. Cardiol., March 21, 2006; 47(6): 1134 - 1142. [Abstract] [Full Text] [PDF]

				M. Valgimigli, G. A. Rodriguez-Granillo, H. M. Garcia-Garcia, P. Malagutti, E. Regar, P. de Jaegere, P. de Feyter, and P. W. Serruys Distance from the ostium as an independent determinant of coronary plaque composition in vivo: an intravascular ultrasound study based radiofrequency data analysis in humans Eur. Heart J., March 2, 2006; 27(6): 655 - 663. [Abstract] [Full Text] [PDF]

				K. Watanabe, S. Sugiyama, K. Kugiyama, O. Honda, H. Fukushima, H. Koga, Y. Horibata, T. Hirai, T. Sakamoto, M. Yoshimura, et al. Stabilization of Carotid Atheroma Assessed by Quantitative Ultrasound Analysis in Nonhypercholesterolemic Patients With Coronary Artery Disease J. Am. Coll. Cardiol., December 6, 2005; 46(11): 2022 - 2030. [Abstract] [Full Text] [PDF]

				J. Herrmann Peri-procedural myocardial injury: 2005 update Eur. Heart J., December 1, 2005; 26(23): 2493 - 2519. [Abstract] [Full Text] [PDF]

				J. G. Robinson, B. Smith, N. Maheshwari, and H. Schrott Pleiotropic Effects of Statins: Benefit Beyond Cholesterol Reduction?: A Meta-Regression Analysis J. Am. Coll. Cardiol., November 15, 2005; 46(10): 1855 - 1862. [Abstract] [Full Text] [PDF]

				P. Raggi, A. Taylor, Z. Fayad, D. O'Leary, S. Nissen, D. Rader, and L. J. Shaw Atherosclerotic Plaque Imaging: Contemporary Role in Preventive Cardiology Arch Intern Med, November 14, 2005; 165(20): 2345 - 2353. [Abstract] [Full Text] [PDF]

				R. P. Giugliano and E. Braunwald The Year in Non--ST-Segment Elevation Acute Coronary Syndromes J. Am. Coll. Cardiol., September 6, 2005; 46(5): 906 - 919. [Full Text] [PDF]

				H.-J. Priebe Perioperative myocardial infarction--aetiology and prevention Br. J. Anaesth., July 1, 2005; 95(1): 3 - 19. [Abstract] [Full Text] [PDF]

				M. Kawasaki, K. Sano, M. Okubo, H. Yokoyama, Y. Ito, I. Murata, K. Tsuchiya, S. Minatoguchi, X. Zhou, H. Fujita, et al. Volumetric Quantitative Analysis of Tissue Characteristics of Coronary Plaques After Statin Therapy Using Three-Dimensional Integrated Backscatter Intravascular Ultrasound J. Am. Coll. Cardiol., June 21, 2005; 45(12): 1946 - 1953. [Abstract] [Full Text] [PDF]

				R. Schulz Pleiotropic effects of statins: Acutely good, but chronically bad? J. Am. Coll. Cardiol., April 19, 2005; 45(8): 1292 - 1294. [Full Text] [PDF]