Vulnerable plaques and lipid changes over statin therapy in patients with acute coronary syndrome. Initial data from the Combi-LLT ACS trial

Aim. To assess the detection rate of vulnerable plaques using computed tomography (CT) in patients after acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI). Material and methods. The study included 125 patients with ACS who underwent PCI (men, 68%; median age, 59 (51-66) years). One month after the index event, patients who did not achieve target low-density lipoprotein cholesterol values were divided into two groups depending on the signs of vulnerable plaques according to CT data. Results. Vulnerable plaques were detected in 56 (44,8%) patients using CT (69,6% men, median age 60 (51-63) years). Patients with vulnerable plaques were more likely to have right coronary artery (CA) involvement — 53,6 vs 11,6% (p<0,001); left main CA — 33,9 vs 5,8% (p<0,001); left anterior descending artery — 76,8 vs 15,9% (p<0,001); circumflex artery — 48,2 vs 18,8% (p<0,001) compared to patients without vulnerable plaques. The coronary calcium index in patients with vulnerable plaques was significantly higher — 111 (29-247) vs 35 (1-138) (p=0,003). Patients with signs of vulnerable plaques had more severe coronary artery disease according to the segment-stenosis (SSS) and segment-involvement (SIS) scores — 3 (1-4) vs 0 (0-1) (p<0,001) compared to patients without vulnerable plaques. Conclusion. The detection rate of vulnerable plaques in patients after ACS and PCI not achieved target LDL values while receiving highdose statin therapy was 44,8%. Patients with vulnerable plaques were characterized by more spread atherosclerotic coronary involvement and a high calcium index.