MedicalResearch.com Interview with:
Lorenz Räber, MD, PhD
Director Division CAD and MI
INSELSPITAL, Bern University Hospital
Medical Research: What is the background for this study?
Response: Inflammation is a key player in the pathobiology of atheorsclerosis. Inflammatory markers and specifically C-reactive protein (CRP) associate with statin-mediated clinical event reduction and plaque burden reduction in patients with stable CAD. Whether CRP correlates with changes in plaque composition, ie. an important presumed substrate of plaque vulnerability, remains unknown. We thought to assess compositional atheroma changes by means of virtual histology IVUS in relation to levels of hs-CRP in STEMI patients. For this purpose, we performed intracoronary imaging using virtual histology IVUS in the proximal part of the two non-infarct related coronary arteries of STEMI patients at baseline and 13 months follow-up (IBIS-4 study). A total of 44 patients with 80 vessels had serial imaging and hsCRP measurements available.
Medical Research: What are the main findings?
Response: This is the first study to show that serial changes and on-treatment levels of hs-CRP correlate with virtual histology IVUS-defined necrotic core content in patients with STEMI receiving high-intensity statin therapy. Patients with a low inflammatory activity are more likely to achieve a reduction in necrotic core, which represents a presumed substrate of plaque vulnerability. These findings may provide the basis for assessing inflammation at follow-up to monitor disease activity in STEMI patients.
Medical Research: What should clinicians and patients take away from your report?
Response: The assessment of inflammatory markers at follow-up may identify STEMI patients at higher risk for future cardiovascular events during long-term follow-up considering that in those patients necrotic core increases despite the presence of high-intensity statin therapy.
Medical Research: What recommendations do you have for future research as a result of this study?
Response: Further studies need to determine whether virtual histology IVUS derived necrotic core stabilization or regression could translate into improved clinical outcomes. Further, it appears of interest to investigate whether the assessment of serological inflammatory markers could improve the management of high risk coronary artery disease patients.
Changes of coronary plaque composition correlate with C-reactive protein levels in patients with ST-elevation myocardial infarction following high-intensity statin therapy
Koskinas, Konstantinos C. et al.
Atherosclerosis , Volume 0 , Issue 0 ,
Lorenz Räber, MD, PhD (2016). Biomarker CRP Correlates With Coronary Plaque In STEMI Patients on Statins