Article Impact Level: HIGH Data Quality: STRONG Summary of Journal of the American College of Cardiology, 82(18), 1737–1747. https://doi.org/10.1016/j.jacc.2023.08.019 Dr. Flavio G. Biccirè et al.
Points
- The study investigated the occurrence, determinants, and prognostic implications of triple regression in patients with acute myocardial infarction (AMI) treated with high-intensity lipid-lowering therapy.
- The PACMAN-AMI trial compared the effects of alirocumab (a PCSK9 antibody) to those of placebo in patients receiving high-intensity statin therapy.
- Triple regression, defined as a reduction in atheroma volume, a reduction in maximum lipid core burden index to within 4 mm, and an increase in minimal fibrous cap thickness, occurred in approximately one-third of patients with AMI.
- Patients with triple regression had lower on-treatment low-density lipoprotein cholesterol levels and a lower incidence of the composite clinical endpoint of death, myocardial infarction, and ischemia-driven revascularization.
- The study suggests that high-intensity lipid-lowering therapy, particularly with alirocumab, may promote atheroma regression and improve clinical outcomes in patients with AMI.
Summary
Researchers aimed to investigate the frequency, characteristics, and outcomes of patients treated with high-intensity lipid-lowering therapy, showing concomitant atheroma volume reduction, lipid content reduction, and increase in fibrous cap thickness (i.e., triple regression).
The PACMAN-AMI (Effects of the PCSK9 Antibody Alirocumab on Coronary Atherosclerosis in Patients with Acute Myocardial Infarction) trial was conducted to compare the effects of alirocumab versus placebo in patients receiving high-intensity statin therapy. The trial utilized serial intravascular ultrasound, near-infrared spectroscopy, and optical coherence tomography to assess the effects of the treatments. Triple regression was defined as the combined presence of a percentage of atheroma volume reduction, maximum lipid core burden index within 4 mm reduction, and minimal fibrous cap thickness increase.
Of the 265 patients included in the study, 84 (31.7%) exhibited triple regression. The rate of triple regression was significantly higher in the alirocumab group (40.8%) compared to the placebo group (23.0%). Patients with triple regression had lower on-treatment low-density lipoprotein cholesterol levels compared to those without triple regression, with a between-group difference of -27.1 mg/dL. The occurrence of triple regression was independently predicted by alirocumab treatment (odds ratio [OR]: 2.83) and a higher baseline maximum lipid core burden index within 4 mm (OR: 1.03).
Furthermore, the study assessed the clinical outcomes at a 1-year follow-up. The composite clinical endpoint of death, myocardial infarction, and ischemia-driven revascularization occurred less frequently in patients with triple regression (8.3%) compared to those without triple regression (18.2%). These findings suggest that triple regression, observed in one-third of patients with acute myocardial infarction receiving high-intensity lipid-lowering therapy, is associated with alirocumab treatment, higher baseline lipid content, and reduced cardiovascular events.
In conclusion, the PACMAN-AMI trial provides valuable insights into the rates, determinants, and prognostic implications of triple regression in patients with acute myocardial infarction. The study demonstrates the potential benefits of high-intensity lipid-lowering therapy, particularly with alirocumab, in promoting atheroma regression and improving clinical outcomes in this patient population.
Link to the article: https://www.sciencedirect.com/science/article/abs/pii/S0735109723064689
References Biccirè, F. G., Häner, J., Losdat, S., Ueki, Y., Shibutani, H., Otsuka, T., Kakizaki, R., Hofbauer, T. M., Van Geuns, R.-J., Stortecky, S., Siontis, G. C. M., Bär, S., Lønborg, J., Heg, D., Kaiser, C., Spirk, D., Daemen, J., Iglesias, J. F., Windecker, S., … Räber, L. (2023). Concomitant Coronary Atheroma Regression and Stabilization in Response to Lipid-Lowering Therapy. Journal of the American College of Cardiology, 82(18), 1737–1747. https://doi.org/10.1016/j.jacc.2023.08.019
