title: Reverse vessel remodeling but not coronary plaque regression could predict future cardiovascular events in ACS patients with intensive statin therapy--the extended JAPAN-ACS study.
abstract: BACKGROUND
  The JAPAN-ACS study demonstrated that statins significantly reduced coronary plaque volume in patients with acute coronary syndrome (ACS). The clinical implications of plaque regression for clinical outcomes in ACS patients has not been established. The Extended JAPAN-ACS study was conducted to evaluate the relationship between coronary plaque regression and long-term clinical outcome, and to explore the factors associated with cardiovascular events.
  
  
  RESULTS
  Patients with intravascular ultrasound (IVUS) data at both enrollment and follow-up in the JAPAN-ACS study were enrolled and observed for at least 3 years. Patients were divided into lesser and greater coronary plaque regression groups. The primary endpoint was defined as a composite of the following events: cardiovascular death, nonfatal myocardial infarction, nonfatal cerebral infarction, and unstable angina. The median value of the percent change in plaque volume, 18.0%, was used as a cutoff point. There were 4 primary events (3.4%) in the lesser regression group, and 2 events (1.7%) in the greater regression group (P=0.4). Cumulative secondary cardiovascular events did not differ between the 2 groups. Multivariate analysis identified the high-density lipoprotein cholesterol (HDL-C) at baseline and the % change of the external elastic membrane volume as independent risk factors of cardiovascular events.
  
  
  CONCLUSIONS
  Coronary plaque regression induced by an intensive statin regimen did not predict future cardiovascular events in ACS patients. Rather, the baseline HDL-C level and reverse vessel remodeling might serve as predictors for cardiovascular events.
authors.affiliation: Department of Cardiology, Juntendo University School of Medicine, Tokyo 113-8421, Japan. ktmmy@juntendo.ac.jp
authors.forename: Katsumi
authors.initials: K
authors.lastname: Miyauchi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Daida
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.forename: Takafumi
authors.initials: T
authors.lastname: Hiro
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nakagawa
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yamagishi
authors.forename: Yukio
authors.initials: Y
authors.lastname: Ozaki
authors.forename: Kazushige
authors.initials: K
authors.lastname: Kadota
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kimura
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hirayama
authors.forename: Kazumi
authors.initials: K
authors.lastname: Kimura
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Hasegawa
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Uchiyama
authors.forename: Masunori
authors.initials: M
authors.lastname: Matsuzaki
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D000368:Aged; D000789:Angina, Unstable / Q000209:etiology; D000069059:Atorvastatin; D015415:Biomarkers / Q000097:blood; D002544:Cerebral Infarction / Q000209:etiology; D008076:Cholesterol, HDL / Q000097:blood; D003324:Coronary Artery Disease / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006538:Heptanoic Acids / Q000627:therapeutic use*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology; D058226:Plaque, Atherosclerotic / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011758:Pyrroles / Q000627:therapeutic use*; D011804:Quinolines / Q000627:therapeutic use*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D015415:Biomarkers; D008076:Cholesterol, HDL; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D011804:Quinolines; D000069059:Atorvastatin; C108475:pitavastatin