title: Atherosclerotic coronary plaque regression and the risk of adverse cardiovascular events: a meta-regression of randomized clinical trials.
abstract: BACKGROUND
  Atherosclerotic coronary plaques represent the main substrate for coronary artery disease (CAD), and changes in plaque volume, investigated with intravascular ultrasound (IVUS), have been used as surrogate end-points in several clinical trials. However, no conclusive data are available to support the exploitation of IVUS-based plaque changes as a measure of clinically meaningful treatment's effect.
  
  
  METHODS
  Biomed Central, CENTRAL, and Medline/PubMed were searched for randomized clinical trials investigating IVUS variations of plaque and reporting clinical events. End-points of interest were major adverse cardiovascular events (MACE, a composite of death, myocardial infarction [MI] or revascularization), and the rates of MI or revascularization combined. Meta-regression analysis was performed to appraise the association between plaque changes and clinical events during follow-up.
  
  
  RESULTS
  Eleven studies (2 focusing on patients with ACS) with 7864 patients were included. After a median follow-up of 18 months, percentage of atheroma volume (PAV) was 0.50 (95% confidence interval -0.25; 1.00), with a 15.0% (95% CI 9.6%; 22.5%) rate of MACE and a 14.1% (95% CI 10.2%; 19.5%) rate of MI or revascularization. Rates of plaque volume regression were significantly associated with the incidence of MI or revascularization (Beta = 6.3; p = 0.006) but not with MACE (Beta = 0.42; p = 0.208).
  
  
  CONCLUSIONS
  Regression of atherosclerotic coronary plaque volume may represent a surrogate for myocardial infarction and repeat revascularization but not for MACE. These results derive largely from stable patients, and should consequently be applied only to this population.
authors.affiliation: Division of Cardiology, University of Turin, Italy. fabrizio.dascenzo@gmail.com
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Agostoni
authors.forename: Antonio
authors.initials: A
authors.lastname: Abbate
authors.forename: Davide
authors.initials: D
authors.lastname: Castagno
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lipinski
authors.forename: George W
authors.initials: GW
authors.lastname: Vetrovec
authors.forename: Giacomo
authors.initials: G
authors.lastname: Frati
authors.forename: Davide Giacomo
authors.initials: DG
authors.lastname: Presutti
authors.forename: Giorgio
authors.initials: G
authors.lastname: Quadri
authors.forename: Claudio
authors.initials: C
authors.lastname: Moretti
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
authors.forename: Giuseppe Biondi
authors.initials: GB
authors.lastname: Zoccai
mesh_terms: D002318:Cardiovascular Diseases / Q000209:etiology*; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D058226:Plaque, Atherosclerotic / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000473:pathology; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D018084:Ultrasonography, Interventional