Influence Of Ezetimibe On Plaque Morphology In Patients With St Elevation Myocardial Infarction Assessed By Optical Coherence Tomography: An Octivus Sub-Study

Aims: The aim of the trial was to examine the influence of ezetimibe on plaque morphology in patients with ST-segment Elevation Myocardial Infarction (STEMI) with respect to fibrous cap thickness (FCT) and arcs of lipid plaque, calcific plaque, and macrophages using Optical Coherence Tomography (OCT).Methods and results: In 87 statin naive patients with STEMI treated with primary percutaneous intervention, a non-culprit study plaque in a non-infarct related coronary artery was assessed with OCT at baseline and after 12 months. Patients were treated with atorvastatin 80 mg and randomized (1:1) to ezetimibe 10 mg (n = 43) or placebo (n = 44). An increase in median FCT (ezetimibe 200 (140-260) mu m to 240 (190-305) mu m (p = 0.002) vs. placebo 205 (135-260) mu m to 230 (180-270) mu m (p = 0.001), between groups p = ns), a reduction in lipid arc (ezetimibe 1728.5 (1022.5-3904.7)degrees to 1164.5 (736.6-2580.1)degrees (p = 0.001) vs. placebo 1671.6 (978.3-2868.7)degrees to 1373.7 (791.2-2267.3)degrees (p = 0.019), between groups p = ns), and macrophage arc (ezetimibe 1730.3 (965.7-2984.4)degrees to 1324.8 (819.0-2819.7)degrees (p b 0.05) vs. placebo 1570.5 (794.7-3016.8)degrees to 1418.9 (584.1-2501.1)degrees (p < 0.01), between groups p = ns) were observed.Conclusion: Aggressive LDL-lowering resulted in changes in OCT assessed plaque composition by increased FCT thickness and a reduction in lipid content and macrophage infiltration. Addition of ezetimibe 10 mg to atorvastatin 80 mg resulted in further LDL reduction, but no additional change in plaque composition was found. (C) 2019 Elsevier Inc. All rights reserved.