PURPOSE: The aim of this study was to demonstrate the early effects of statin treatment on plaque composition according to plaque stability on Intravascular Ultrasound-Virtual Histology at 6 months after a coronary event. Previous trials have demonstrated that lipid lowering therapy with statins decreases plaque volume and increases plaque echogenicity in patients with coronary artery disease. MATERIALS AND METHODS: Fifty-four patients (54 lesions) with acute coronary syndrome were prospectively enrolled. We classified and analyzed the target plaques into two types according to plaque stability: thin-cap fibroatheroma (TCFA, n=14) and non-TCFA (n=40). The primary end point was change in percent necrotic core in the 10-mm subsegment with the most disease. RESULTS: After 6 months of statin therapy, no change was demonstrated in the mean percentage of necrotic core (18.7+/-8.5% to 20.0+/-11.0%, p=0.38). There was a significant reduction in necrotic core percentage in patients with TCFA (21.3+/-7.2% to 14.4+/-8.9%, p=0.017), but not in patients with non-TCFA. Moreover, change in percent necrotic core was significantly correlated with change in high-sensitivity C-reactive protein levels (r=0.4, p=0.003). Changes in low-density lipoprotein cholesterol levels and lipid core percentage demonstrated no significant associations. CONCLUSION: A clear reduction of lipid core was observed only for the TCFA plaque type, suggesting that changes in plaque composition following statin therapy might occur earlier in vulnerable plaque than in stable plaque; the effect may be related to the anti-inflammatory effects of statins.
Acute Coronary Syndrome/*drug therapy/ultrasonography ; Aged ; C-Reactive Protein/metabolism ; Female ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic use ; Male ; Middle Aged ; Plaque, Atherosclerotic/*ultrasonography ; Ultrasonography, Interventional

OBJECTIVETo compare the efficacy and safety between the interventional and conservative treatment options for borderline vulnerable plaque lesion in acute coronary syndrome (ACS) patients by intravascular ultrasound (IVUS).

METHODSA total of 100 ACS patients [78 male, age 43 - 74 (60.4 ± 14.1) years] undergoing coronary angiography (CAG) with borderline lesion (coronary artery stenosis between 50% - 70%) were enrolled in May 2007 to February 2009, who were randomly divided into PCI group (50 patients) and conservative therapy group (50 patients). According to minimal lumen area (MLA) detected by IVUS, patients were further divided into MLA ≥ 4.0 mm(2) sub-group and MLA < 4.0 mm(2) sub-groups. Outcomes during hospitalization and after 10 - 12 month follow-up were compared.

RESULTSIVUS was performed in 40 patients at 10 - 12 months post PCI, there was no in-stent thrombosis and the extent of stent neointimal hyperplasia was comparable as at the time of immediately post PCI. IVUS was performed in 35 patients at 10 - 12 months post conservative therapy, IVUS results showed that MLA increased significantly [(7.32 ± 1.42) mm(2) vs. (4.98 ± 0.89) mm(2), P < 0.01], while plaque area [(7.70 ± 2.09) mm(2) vs. (10.01 ± 2.55) mm(2), P < 0.05], plaque burden [(55.94 ± 8.36)% vs. (67.97 ± 9.36)%] and low echo area [(4.08 ± 0.80) mm(2) vs. (2.27 ± 0.79) mm(2)] were significantly decreased at follow up compared to those as baseline (all P < 0.01). There was one patient in PCI group with MLA ≥ 4.0 mm(2) developed acute in-stent thrombosis in left anterior descending artery two days after the procedure and 9 patients in conservative therapy and MLA < 4.0 mm(2) group received PCI due to recurrent angina pectoris during follow-up.

CONCLUSIONSFor the borderline lesion with MLA ≥ 4.0 mm(2) detected by IVUS, adequate medication could effectively attenuate and or reverse the plaque progression and stabilize plaque.

Acute Coronary Syndrome ; drug therapy ; therapy ; Adult ; Aged ; Catheter Ablation ; Coronary Angiography ; Female ; Humans ; Male ; Middle Aged ; Plaque, Atherosclerotic ; diagnosis ; Treatment Outcome ; Ultrasonography, Interventional

BACKGROUNDIt has been shown that administration of statins reduced the risk of peri-procedural myocardial damage. However, it remains unclear whether Chinese medicine Danlou Tablet (), similar to statins, may protect patients undergoing percutaneous coronary intervention (PCI) from peri-procedural myocardial damage.

OBJECTIVETo demonstrate the hypothesis whether treatment with Danlou Tablet would improve clinical outcome in patients undergoing selective PCI with non-ST elevation acute coronary syndrome (NSTE-ACS) in China.

METHODSApproximately 220 patients with unstable angina or non-ST-segment elevation myocardial infarction undergoing PCI will be enrolled and randomized to Danlou Tablet treatment (4.5 g/day for 2 days before intervention, with a further 4.5 g/day for 90 days thereafter) or placebo. All patients will not receive Danlou Tablet before procedure. The primary end point is to evaluate the incidence of cardiac death, myocardial infarction or unplanned re-hospitalization and revascularization after 30 days in patients undergoing selective PCI treated with Danlou Tablet compared with placebo. Secondary endpoints include the incidence of peri-procedural myocardial injury, 3-month clinical outcomes, the quality of life and Chinese medicine syndromes assessment.

CONCLUSIONThis study protocol will provide important evidence of Danlou Tablet treatment on the peri-procedural myocardial injury in patients with NSTE-ACS undergoing selective PCI, which may support a strategy of routine Danlou Tablet therapy to improve the clinical outcomes.

Acute Coronary Syndrome ; diagnostic imaging ; drug therapy ; Drugs, Chinese Herbal ; therapeutic use ; Electrocardiography ; Endpoint Determination ; Humans ; Myocardium ; pathology ; Percutaneous Coronary Intervention ; Sample Size ; Ultrasonography

OBJECTIVETo investigate the effects of Chinese herbs for supplementing qi, nourishing yin and activating blood circulation on heart function of patients with acute coronary syndrome (ACS) after successful percutaneous coronary intervention (PCI).

METHODSOne hundred patients with ACS after successful PCI were randomly assigned to a Western medicine (WM) treatment group (WMG) and a combined treatment group (CMG) treated by Chinese herbs for supplementing qi, nourishing yin and activating blood circulation, besides Western medicine treatment, with 50 cases in each group. Both treatment courses were 6 months. The followup was scheduled at baseline, 6 months and 1 year after PCI, and New York Heart Association (NYHA) functional class, Chinese medicine (CM) symptom scores, blood stasis syndrome scores, and major adverse cardiovascular events (MACE) were observed, serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and hyper-sensitivity C-reactive protein (Hs-CRP) were measured, an echocardiogram was conducted to examine left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), inter-ventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), and ventricular wall motion index (VWMI).

RESULTSCompared with the baseline, LVEF significantly increased (P<0.01), and CM symptom scores, blood stasis syndrome scores, VWMI, LVEDV, LVESV, NT-proBNP, and Hs-CRP all decreased (P<0.01) in both groups at 6 months and at 1 year after PCI. There were no significant differences in all the above parameters at 1 year vs those at 6 months after PCI (P>0.05). VWMI, LVEDV, LVESV, NT-proBNP, Hs-CRP, LVEF, and CM symptom and blood stasis syndrome scores were all improved obviously in CMG than those in WMG (P<0.05 or P<0.01) at 6 months and at 1 year after PCI. There were no significant differences in NYHA functional class between CMG and WMG at different follow-up timepoints; it was notable that value was 0.054 when comparing the cases of NYHA functional class between the two groups at 1-year follow-up. During the 1-year follow-up, 3 MACE and 11 MACE occurred in CMG and WMG, respectively; the MACE rate in CMG was lower than that in WMG (6% vs 22%, P<0.05).

CONCLUSIONChinese herbs for supplementing qi, nourishing yin and activating blood circulation could improve heart function, reduce the CM symptom scores and blood stasis syndrome scores, and decrease the incidence of MACE in patients with ACS after successful PCI.

Acute Coronary Syndrome ; blood ; drug therapy ; physiopathology ; surgery ; C-Reactive Protein ; metabolism ; Cardiotonic Agents ; adverse effects ; pharmacology ; therapeutic use ; China ; epidemiology ; Coronary Circulation ; drug effects ; Drugs, Chinese Herbal ; adverse effects ; pharmacology ; therapeutic use ; Female ; Heart Function Tests ; drug effects ; Humans ; Incidence ; Male ; Middle Aged ; Natriuretic Peptide, Brain ; blood ; New York ; Peptide Fragments ; blood ; Percutaneous Coronary Intervention ; adverse effects ; Postoperative Complications ; epidemiology ; etiology ; Qi ; Societies, Medical ; Syndrome ; Ultrasonography ; Yin-Yang