title: Impact of chronic statin therapy on clinical presentation and underlying lesion morphology in patients undergoing percutaneous intervention: an ADAPT-DES IVUS substudy.
abstract: OBJECTIVE
  Previous intravascular ultrasound (IVUS) studies have not established a relationship between chronic statin use and plaque morphology and composition in patients undergoing percutaneous coronary intervention (PCI). We sought to use pre-PCI grayscale and virtual histology (VH)-IVUS to assess plaque morphology and composition in patients treated with chronic statin therapy compared with patients who were not taking statins before admission and PCI.
  
  
  METHODS
  In a prespecified substudy of the Assessment of Dual AntiPlatelet Therapy with Drug-Eluting Stents study, pre-PCI grayscale and VH-IVUS were performed in 780 patients with 916 culprit and 765 nonculprit lesions.
  
  
  RESULTS
  Overall, 338 patients were treated with chronic statin therapy before admission. Statin-treated patients were older and had a higher prevalence of coronary risk factors. Statin-treated patients were more likely to present with stable angina, whereas non-statin-treated patients more frequently presented with acute myocardial infarction. Grayscale and VH-IVUS findings showed that lesions in statin-treated patients had a smaller plaque burden, but more dense calcium. Statin-treated patients had more calcified thick-cap fibroatheromas (9.2 vs. 3.7%, P=0.0007), but fewer VH-defined thin-cap fibroatheromas (45.2 vs. 56.1%, P=0.001) or plaque ruptures (26.6 vs. 38.4%, P=0.0001). In a propensity-matched population (n=249 in each group), similar results were obtained as regards clinical presentation and grayscale and VH-IVUS findings.
  
  
  CONCLUSIONS
  Chronic statin use in patients with coronary artery disease was associated with more stable clinical presentation and IVUS findings consistent with greater lesion stability (fewer VH-thin-cap fibroatheromas and plaque ruptures and more calcified thick-cap fibroatheromas).
authors.affiliation: aClinical Trials Center,Cardiovascular Research Foundation bNew York-Presbyterian Hospital/Columbia University Medical Center, NewYork, New York cWellmont CVA Heart Institute, Kingsport, Tennessee dSanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte eReid Heart Center, FirstHealth of the Carolinas, Pinehurst fLeBauer-Brodie Center for Cardiovascular Research and Education/Cone Health, Greensboro, North Carolina gThe Ohio State University Wexner Medical Center, Columbus, Ohio, USA hShaare Zedek Medical Center, Jerusalem, Israel iFederal University of São Paulo, São Paulo, Brazil jHelios Amper-Klinikum, Dachau, Germany.
authors.forename: Tadayuki
authors.initials: T
authors.lastname: Kadohira
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.forename: Cristiano F
authors.initials: CF
authors.lastname: Souza
authors.forename: Bernhard
authors.initials: B
authors.lastname: Witzenbichler
authors.forename: D Christopher
authors.initials: DC
authors.lastname: Metzger
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rinaldi
authors.forename: Ernest L
authors.initials: EL
authors.lastname: Mazzaferri
authors.forename: Peter L
authors.initials: PL
authors.lastname: Duffy
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Stuckey
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Brodie
authors.forename: Aaron
authors.initials: A
authors.lastname: Crowley
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: Akiko
authors.initials: A
authors.lastname: Maehara
mesh_terms: D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000473:pathology; D003430:Cross-Sectional Studies; D005260:Female; D005355:Fibrosis; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D058226:Plaque, Atherosclerotic; D057216:Propensity Score; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D012422:Rupture, Spontaneous; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors