Objective To evaluate the effect of atrovastatin therapy on borderline vulnerable lesions in patients with acute coronary syndrome (ACS) and to investigate the relationship between lesion reversion and the level of MMP-9, TIMP-1, hs-CRP respectively.
Methods Patients with ACS whose serum LDL-C is lower than 2.1 mmol/L underwent coronary angiography (CAG) and intravascular ultrasound (IVUS) investigation. If the culprit lesions were demonstrated to be borderline lesions (coronary artery stenosis between 50-70%) by CAG and minimal lumen cross-sectional area (CSA) >4.0 mm2 by IVUS, the patients were enrolled in the present study. Intravascular ultrasound was performed to assess coronary atheroma at baseline and 12 months after atrovastatin therapy. The level of MMP-9, TIMP-1, hs-CRP were respectively measured by ELISA at baseline and 12 month-follow-up.
Results No adverse events were reported during follow-up period. Comparing with baseline data, the level of ApoB decreased significantly at the end of the study (0.589±0.136 g/l vs 0.681±0.132 g/l, p=0.03). at 12 month IVUS follow-ups, minimal lumen CSA increased ((6.32+1.42) mm2 vs (4.63+0.51) mm2, p<0.01), the plaque/media (P&M) area decreased (6.70±1.19 mm2 vs 8.17±1.55 mm2), p<0.05; Plaque Burden decreased (56.94±8.47% vs 61.4±10.34%, p<0.01). A total of 25 soft plaques (50%) transformed into fibrous plaque. Comparing with baseline data, level of MMP-9 and hs-CRP decreased at the end of the study, ((1636+483) ng/ml vs (2241+354) ng/ml, p<0.001) and ((0.39+0.19 mg/l) vs (3.48+1.50) mg/l, p<0.001), respectively. TIMP-1 increased ((788+110) ng/ml vs (664+102) ng/ml, p<0.001). In stepwise multivariate linear regression analysis, the only independent predictor of changes in P&M area per year was decrement of MMP-9 and hs-CRP (γ=0.85, p<0.01, and γ=0.83, p<0.01, respectively). Regression equation is Annual Change of P&M area=−1.327+0.003 Annual Change of MMP-9 +0.344 Annual Change of hs-CRP, R Square=0.830, Adjusted R Square=0.819, F=78.152, p=0.000.
Conclusions Atrovastatin therapy stabilises borderline vulnerable plaque and reverses atherosclerosis progression in patients with ACS. Reversion of the atherosclerotic progression of vulnerable plaque is accompanied by the decrement of the level of plasma MMP-9 and hs-CRP. Changes in the level of MMP-9 and hs-CRP could predict the stabilisation of vulnerable plaque.
- Intravascular ultrasound
- statin treatment
- acute coronary syndrome
- vulnerable plaque