Clinically evident polyvascular disease and regression of coronary atherosclerosis after intensive statin therapy in patients with acute coronary syndrome: Serial intravascular ultrasound from the Japanese assessment of pitavastatin and atorvastatin in acute coronary syndrome (JAPAN-ACS) trial

Aim: To clarify whether the effects of statin treatment on plaque regression vary according to the presence or absence of polyvascular disease (PVD) in patients with acute coronary syndrome (ACS). Methods: 307 patients with ACS who underwent percutaneous coronary intervention for the culprit lesion at 33 centers were treated with atorvastatin or pitavastatin. Noncoronary atherosclerosis was defined as coexistent, clinically recognized arterial disease other than coronary artery disease (CAD) (cerebral, aortic, or lower extremity). Intravascular ultrasound (IVUS) was performed to assess non-culprit coronary atherosclerosis at baseline and at 8-12 months follow-up. Serial IVUS examinations were obtained in 252 patients. Atheroma volume and percent change in atheroma volume of the target plaque was assessed. Results: Patients of the CAD+PVD (n=19) were older (68 vs. 62 years, p=0.02), had lower low-density lipoprotein cholesterol (LDL-C) levels at baseline (116 vs. 134mg/dL, p=0.03) than those of the CAD-only group (n=233), whereas LDL-C levels at follow-up were similar (81 vs. 83mg/dL). Although the baseline plaque volume was similar in the two groups (59 vs. 57mm³), patients of the CAD+PVD group showed milder regression of atherosclerosis than those of the CAD-only group (-8.9% vs. -18.2%, p=0.005). This difference remained significant even after adjustment for coronary risk factors including age and serum LDL-C (p=0.047). Conclusions: Statin treatment results in milder regression of coronary atherosclerosis in CAD patients with polyvascular disease compared to those with CAD only.