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Cardiovascular Intervention and Therapeutics

, Volume 33, Issue 4, pp 360–371 | Cite as

Effect of low-density lipoprotein cholesterol on the geometry of coronary bifurcation lesions and clinical outcomes of coronary interventions in the J-REVERSE registry

  • Yoshinobu Murasato
  • Yoshihisa Kinoshita
  • Masahiro Yamawaki
  • Toshiro Shinke
  • Yoshihiro Takeda
  • Kenichi Fujii
  • Shin-ichiro Yamada
  • Yoshihisa Shimada
  • Takehiro Yamashita
  • Kazuhiko Yumoto
  • On behalf of J-REVERSE investigators
Original Article
  • 84 Downloads

Abstract

We investigated the effect of low-density lipoprotein cholesterol (LDL-C) on the geometry of coronary bifurcation lesions. A total of 300 non-left main bifurcation lesions in 298 patients from J-REVERSE registry were classified according to statin treatment status at admission (NT, non-treated; ST, statin-treated) and were further subdivided based on LDL-C levels with a cutoff of 100 mg/dL (NT–high, n = 76 lesions; NT–low, n = 46; ST–high, n = 99 and ST–low, n = 79). In addition, a group with strict control of LDL-C (< 70 mg/dL) was defined (ST–SC; n = 19). The NT–high group had higher angled bifurcations compared to that in the NT–low group (59.1° ± 21.5° vs. 50.3° ± 18.6°, p = 0.02). In the multivariate analysis, NT–high group was an independent factor contributing on generation of higher angled (> 80°) lesion (odds ratio 3.77, 95% CI 1.05–13.5, p = 0.04). The NT–low group had more men (95.6 vs. 81.6%, p = 0.03), and greater plaque volume in the distal main vessel (7.1 ± 3.2 mm3/mm vs. 5.7 ± 2.7 mm3/mm, p = 0.02), compared to those in the NT–high group. LDL-C was more likely to remain high after statin treatment in younger patients (65.3 ± 3.6 years vs. 68.6 ± 8.4 years, p = 0.02) and current smokers (36.7 vs. 16.9%, p = 0.004). The ST–SC group had limited luminal volume expansion compared to that in the ST–high group (proximal: 6.7 ± 1.4 mm3/mm vs. 7.7 ± 2.3 mm3/mm, p = 0.04; distal: 5.3 ± 1.5 mm3/mm vs. 6.5 ± 1.9 mm3/mm, p = 0.04), regardless of similar plaque volumes. Elevated LDL-C is likely to promote the generation of higher angled bifurcation lesions and multiple risk factors lead to a more progressed bifurcation lesion even in patients with lower LDL-C levels.

Keywords

Coronary bifurcation lesion Low-density lipoprotein cholesterol Bifurcation angle Intravascular ultrasound 

Notes

Acknowledgements

J-REVERSE was supported by unrestricted research Grants from Abbott Vascular, Cordis Corporation, Orbus Neich, and Kaneka Corporation.

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Copyright information

© Japanese Association of Cardiovascular Intervention and Therapeutics 2017

Authors and Affiliations

  • Yoshinobu Murasato
    • 1
    • 2
  • Yoshihisa Kinoshita
    • 3
  • Masahiro Yamawaki
    • 4
  • Toshiro Shinke
    • 5
  • Yoshihiro Takeda
    • 6
  • Kenichi Fujii
    • 7
    • 8
  • Shin-ichiro Yamada
    • 9
    • 10
  • Yoshihisa Shimada
    • 11
  • Takehiro Yamashita
    • 12
  • Kazuhiko Yumoto
    • 13
  • On behalf of J-REVERSE investigators
  1. 1.Department of Cardiology, Cardiovascular CenterKyushu Medical CenterFukuokaJapan
  2. 2.Clinical Research Institute, Kyushu Medical CenterFukuokaJapan
  3. 3.Department of Cardiovascular MedicineToyohashi Heart CenterToyohashiJapan
  4. 4.Department of CardiologySaiseikai Yokohama-Eastern HospitalYokohamaJapan
  5. 5.Department of Cardiovascular MedicineKobe UniversityKobeJapan
  6. 6.Department of CardiologyRinku General Medical CenterIzumi-SanoJapan
  7. 7.Department of Cardiovascular MedicineHyogo Medical UniversityNishinomiyaJapan
  8. 8.Department of CardiologyHigashi Takarazuka Sato HospitalTakarazukaJapan
  9. 9.Department of Cardiovascular MedicineHimeji Cardiovascular CenterHimejiJapan
  10. 10.Department of CardiologyKita Harima Medical CenterOnoJapan
  11. 11.Department of Cardiovascular Medicine, Cardiovascular CenterShiroyama HospitalHabikinoJapan
  12. 12.Department of Cardiovascular MedicineCardiovascular Center Hokkaido Ono HospitalSapporoJapan
  13. 13.Department of Cardiovascular MedicineYokohama Rosai HospitalYokohamaJapan

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