P630Comparison of plaque microstructures between two high-intensity statin therapies: rosuvastatin versus atorvastatin

Abstract

Background: Statin therapy has been reported to stabilize coronary plaque, and current guideline recommends high‐intensity atorvastatin or rosuvastatin to reduce cardiovascular events in patients with coronary artery disease. However, no study has compared the impact of these high‐intensity statin therapies on plaque stability. Optical coherence tomography (OCT) enables visualization of plaque microstructures associated with plaque vulnerability.We aimed to investigate plaque morphology in patients with high‐intensity rosuvastatin and high‐intensity atorvastatin. Methods: One hundred seventy non‐culprit lipid plaques in 155 patients with coronary artery disease who received either high‐intensity rosuvastatin (20‐ 40mg) or high‐intensity atorvastatin (40‐80mg) were analyzed. OCT imaging was conducted within target vessel requiring percutaneous coronary intervention (PCI) before procedure. OCT derived microstructures were compared between plaques in patients treated with high‐intensity rosuvastatin (n=72) and those in patients treated with high‐intensity atorvastatin (n=110). Results: Patients with rosuvastatin were more likely to be obese (BMI 34.4 vs. 29.5, p=0.03), and had lower low‐density lipoprotein cholesterol (LDL‐C) (65.9±10.9 vs. 73.7±12.7 mg/dl, p=0.01) and higher high‐density lipoprotein cholesterol (HDL‐C) levels (46.4±15.4 vs. 42.5±7.7 mg/dl, p=0.03) than those with atorvastatin. On OCT analysis, plaques in patients treated with rosuvastatin were less likely to harbor microchannels (6.9 vs. 40.0%, p=0.008) and had smaller lipid burden index defined as lipid arc multiplied by lipid length (652±400 vs. 1269±534 mm°, p=0.01) than those in patients treated with atorvastatin. These differences persisted even after adjusting for clinical demographics, other medication use and risk factor controls (Table). There were no significant differences in fibrous cap thickness, incidence of thrombus, cholesterol crystals and plaque rupture between the groups (all p>0.05). Conclusions: High‐intensity rosuvastatin therapy was associated with lower prevalence of microchannel and smaller lipid burden in coronary plaques in patients with coronary artery disease. These findings may imply more favorable effects of rosuvastatin on plaque stability. (Figure Presented).