Giuseppe Patti, Leonardo Grisafi, Danila Azzolina, Luca Cumitini, Domenico D'Amario, Marco Mennuni
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引用次数: 0
摘要
背景和目的：在接受降脂治疗（LLTs）的患者中，光学相干断层扫描（OCT）冠状动脉斑块表型的变化与主要不良心血管事件（MACE）的减少之间的具体关系尚不清楚。目的是量化llt相关的冠状动脉斑块表型改善（如冠状动脉斑块稳定，由OCT评估）与MACE发生之间的关系。方法：对PubMed、Embase、Cochrane Central Register of Controlled Trials和Web of Science的出版物进行全面、系统的检索，以确定符合条件的研究。共选择了8项关于llt的研究（5项随机研究和3项观察性研究），报告了基线和随访期间平均最大脂质弧（LA）和平均最小纤维帽厚度（FCT），通过OCT评估，以及MACE的发生率，共包括652例患者。结果：平均随访时间8.6个月。meta回归分析显示LA的绝对变化与MACE的发生有显著的直接关系（系数0.055,i20 %, p 2 59 %, p = 0.136）。结论：该分析量化了llt相关的冠状动脉斑块表型改变的潜力，即在治疗的第一年内降低MACE的风险。这些发现表明LA的变化可能是MACE变化的替代指标。
Modifications of coronary plaque phenotype on lipid-lowering therapies and risk of cardiovascular events: a systematic review and meta-regression analysis.
Background and aims: The specific relationship between changes in coronary plaque phenotype by optical coherence tomography (OCT) and decrease in major adverse cardiovascular events (MACE) among patients receiving lipid-lowering therapies (LLTs) is unknown. Aim was to quantify the relationship between LLTs-related improvement of coronary plaque phenotype (e.g. coronary plaque stabilization, as assessed by OCT) and MACE occurrence.
Methods: A comprehensive, systematic search of publications in PubMed, Embase, Cochrane Central Register of Controlled Trials and Web of Science was performed to identify eligible studies. A total of 8 studies (5 randomized and 3 observational) on LLTs reporting mean maximum lipid arc (LA) and mean minimum fibrous cap thickness (FCT) at baseline and during follow-up, as assessed by OCT, and incidence of MACE were selected, encompassing a total of 652 patients.
Results: Mean follow-up duration was 8.6 months. Meta-regression analysis revealed a significant direct relationship between absolute change in LA and MACE occurrence (coefficient 0.055, I2 0 %, p < 0.001), with each 10° decrease in LA being related to a 39 % MACE reduction (OR 0.61, 95 % CI 0.44-0.77). The indirect relationship between absolute change in FCT and risk of MACE was not significant (coefficient -0.011, I2 59 %, p = 0.136).
Conclusions: This analysis quantifies the potential of LLT-related modifications of coronary plaque phenotype in terms of LA decrease for reducing the risk of MACE within the first year of treatment. These findings suggest that LA changes might be a surrogate for changes in MACE.
期刊介绍：
Atherosclerosis has an open access mirror journal Atherosclerosis: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review.
Atherosclerosis brings together, from all sources, papers concerned with investigation on atherosclerosis, its risk factors and clinical manifestations. Atherosclerosis covers basic and translational, clinical and population research approaches to arterial and vascular biology and disease, as well as their risk factors including: disturbances of lipid and lipoprotein metabolism, diabetes and hypertension, thrombosis, and inflammation. The Editors are interested in original or review papers dealing with the pathogenesis, environmental, genetic and epigenetic basis, diagnosis or treatment of atherosclerosis and related diseases as well as their risk factors.
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