Influence of ezetimibe in addition to high-dose atorvastatin therapy on plaque composition in patients with ST-segment elevation myocardial infarction assessed by serial Intravascular ultrasound with iMap: the OCTIVUS trial

摘要

Background: The aim of this study was to examine the influence of ezetimibe in addition to atorvastatin on plaque composition in patients with first-time ST-segment Elevation Myocardial Infarction treated with primary percutaneous intervention. Methods: Eighty-seven patients were randomized (1:1) to ezetimibe 10 mg or placebo in addition to Atorvastatin 80 mg. Intravascular ultrasound with iMap was performed at baseline and after 12 months in a non-infarct-related artery. Primary endpoint was change in necrotic core (NC). Secondary endpoints were total atheroma volume (TAV) and percentage atheroma volume (PAV). Results: NC did not change significantly: ezetimibe group 24.9 (11.9,51.3) mm3 to 24.9 (15.3,54.5) mm3, p = 0.76, placebo group 29.4 (16.3,78.5) mm3 to 32.0 (16.0,88.7) mm3, p - 0.30, (p = 0.35 between groups). TAV was reduced in the ezetimibe group only: ezetimibe (200.0 (135.6,311.9) mm3 to 189.3 (126.4,269.1) mm3, p < 0.001) compared to placebo group (218.4 (163.5,307.9) mm3 to 212.2 (149.9,394.8) mm3, p = 0.07) (p = 0.56 between groups). PAV was reduced in the ezetimibe group only (40.1 ± 8.6% to 39.2 ± 9.0%, p = 0.036) compared to placebo group (43.3 ± 9.4% to 42.2 ± 10.7%, p = 0.07), p = 0.91 between groups. Conclusions: Ezetimibe in addition to atorvastatin therapy did not influence NC content, but was associated with regression of coronary atherosclerosis.