Article Impact Level: HIGH Data Quality: STRONG Summary of European Heart Journal - Cardiovascular Imaging, jead063. https://doi.org/10.1093/ehjci/jead063 Dr. Mark Rabbat et al.
Points
- Icosapent ethyl (IPE) significantly reduces plaque burden and ischaemic events in statin-treated patients with atherosclerosis or diabetes and elevated triglycerides.
- No study had assessed the impact of IPE on coronary physiology until this study analyzed the impact of IPE on fractional flow reserve derived from coronary computed tomography angiography (FFRCT).
- The study demonstrated that IPE significantly improves coronary physiology compared with placebo, as evidenced by the significant improvement in the mean distal segment FFRCT at 9- and 18-month follow-ups.
- The improvement in FFRCT provides mechanistic insight into the clinical benefit observed in the REDUCE-IT trial.
- IPE may be a promising therapy for reducing ischaemic events in statin-treated patients with atherosclerosis or diabetes and elevated triglycerides.
Summary
The EVAPORATE trial enrolled 80 patients with moderate to high-risk atherosclerosis and persistent elevated triglycerides despite statin therapy. The trial demonstrated that IPE significantly reduced plaque volume and had an acceptable safety profile. However, no study to date has assessed the impact of IPE on coronary physiology. The current study sought to address this gap by analyzing the impact of IPE on FFRCT using data from EVAPORATE.
Of the 47 patients studied, 26 were male, and the mean age was 61. The mean baseline triglyceride level was 198 mg/dL. The pre-specified primary endpoint, which was the FFRCT value in the distal coronary segment from baseline to follow-up in the most diseased vessel per patient using IPE compared with placebo, showed a significant improvement in the mean distal segment FFRCT at 9- and 18-month follow-up compared with placebo (0.01 ± 0.05 vs. -0.05 ± 0.09, P = 0.02, and -0.01 ± 0.09 vs. -0.09 ± 0.12, P = 0.03, respectively).
The pre-specified secondary endpoint, which was the change in translesional FFRCT (ΔFFRCT) across the most severe (minimum 30% diameter stenosis) coronary lesion per vessel, showed that ΔFFRCT in 140 coronary lesions was improved, although not statistically significant, with IPE compared with placebo (-0.06 ± 0.08 vs. -0.09 ± 0.1, P = 0.054). The baseline FFRCT was similar for IPE compared with placebo (0.83 ± 0.08 vs. 0.84 ± 0.08, P = 0.55).
In conclusion, the study demonstrated that IPE significantly improves coronary physiology compared with placebo, as evidenced by the significant improvement in the mean distal segment FFRCT at 9- and 18-month follow-ups. The improvement in FFRCT provides mechanistic insight into the clinical benefit observed in the REDUCE-IT trial. The study highlights the importance of assessing FFRCT to determine drug effect. IPE may be a promising therapy for reducing ischaemic events in statin-treated patients with atherosclerosis or diabetes and elevated triglycerides.
Link to the article: https://academic.oup.com/ehjcimaging/advance-article/doi/10.1093/ehjci/jead063/7135508
References Rabbat, M. G., Lakshmanan, S., Benjamin, M. M., Doros, G., Kinninger, A., Budoff, M. J., & Bhatt, D. L. (2023). Benefit of icosapent ethyl on coronary physiology assessed by computed tomography angiography fractional flow reserve: EVAPORATE-FFRCT. European Heart Journal - Cardiovascular Imaging, jead063. https://doi.org/10.1093/ehjci/jead063
