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Coronary disease & ACSSecondary analysis

Lesion-Level Effects of LDL-C–Lowering Therapy in Patients With Acute Myocardial Infarction

JAMA CardiolPublished

  • Secondary analysis of the PACMAN-AMI randomised trial
  • post hoc lesion-level analysis
  • readers blinded to treatment allocation
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Authors' conclusion

At the lesion level, very intensive lipid-lowering therapy induced substantially greater PAV regression than described in previous vessel-level analyses. Compared with statin therapy alone, alirocumab treatment was associated with greater enlargement of the lesion MLA and more frequent transition of presumably high-risk plaque phenotypes into more stable, less lipid-rich plaque phenotypes.

Study context

Population
Patients with acute MI; nonculprit lesions with intravascular ultrasound (IVUS) plaque burden ≥40%
Participants
245 patients · 591 lesions
Comparison
Alirocumab vs placebo on top of high-intensity statin
  • Alirocumabn = 118
  • Placebon = 127reference
Primary endpoint
Lesion-level imaging outcomes, incl. high-risk plaque characteristics and phenotypes
Follow-up
52 weeks

Primary result

As reported in the abstract

Lesion-level change in percent atheroma volume (PAV)

Difference

−2.02

95% CI −3.00 to −1.05

P < 0.001

By group

Alirocumab

−4.86%

mean change

Placebo

−2.78%

mean change

Alirocumab vs Placebo
difference −2.02 (95% CI −3.00 to −1.05); P < 0.001

Further findings

OutcomeAlirocumabPlacebodifference (95% CI)P value
Change in PAV at minimum lumen area (MLA) sitemean change −10.14%mean change −6.70%−3.36 (−4.98 to −1.75)P < 0.001
Change in MLAincrease 0.15 mm²decrease 0.07 mm²0.21 (0.01–0.41)P = 0.04

Less lipid-rich phenotype at follow-up (122 lipid-rich lesions)

P = 0.03

Fibrous/fibrocalcific phenotype at follow-up (63 lesions with thin-cap fibroatheroma)

P = 0.02

  • Less lipid-rich phenotype at follow-up (122 lipid-rich lesions): 34 of 55 vs 27 of 67 lesions
  • Fibrous/fibrocalcific phenotype at follow-up (63 lesions with thin-cap fibroatheroma): 8 of 26 vs 3 of 37 lesions

Original publication

Lesion-Level Effects of LDL-C–Lowering Therapy in Patients With Acute Myocardial Infarction. JAMA Cardiol. Published 1 December 2024. doi:10.1001/jamacardio.2024.3200
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Summarised from the published abstract; every number is checked against it