Introduction
Materials and methods
Patient sample
CCTA protocol
Image reconstruction and analysis of CCTA
CT quantification of PCAT
Statistical analysis
Results
Patient characteristics
Characteristic | Evolocumab | Control | p value |
---|---|---|---|
n = 85 | n = 85 | ||
Age (y)b | 64 ± 8.3 | 65 ± 11.2 | 0.545 |
Men, n (%) | 67 (78.8) | 64 (75.2) | 0.715 |
BMI (kg/m2)b | 24.2 ± 3.3 | 23.5 ± 3.8 | 0.158 |
Risk factors, n (%) | |||
Hypertension | 62 (72.9) | 59 (69.4) | 0.734 |
Hyperlipidemia | 29 (34.1) | 32 (37.6) | 0.749 |
Current or past tobacco use | 15 (17.6) | 19 (22.3) | 0.565 |
Clinical presentation, n (%) | 0.819 | ||
Typical angina | 22 (25.9) | 24 (28.2) | |
Atypical angina | 28 (32.9) | 30 (35.3) | |
Non-anginal pain | 35 (41.1) | 31 (36.4) | |
Baseline statin usea, n (%) | 0.886 | ||
High intensity | 10 (11.8) | 9 (10.6) | |
Moderate intensity | 56 (65.9) | 59 (69.4) | |
Low intensity | 19 (22.3) | 17 (20.0) | |
Baseline insulin in use, n (%) | 19 (22.3) | 17 (20) | 0.851 |
History of myocardial infarction | 18 (21.1) | 21 (24.7) | 0.715 |
History of revascularization | 20 (23.5) | 22 (25.8) | 0.858 |
Heart rate during CT scan | 68 ± 6.9 | 67 ± 6.7 | 0.508 |
β blocker use during CT scan | 68 (80.0) | 71 (83.5) | 0.691 |
Tube voltage of CT acquisition, n (%) | 0.915 | ||
70 kVp | 5 (5.8) | 7 (8.2) | |
80 kVp | 21 (24.7) | 18 (21.1) | |
90 kVp | 25 (29.4) | 23 (27.0) | |
100 kVp | 19 (22.3) | 23 (27.0) | |
110 kVp | 9 (10.8) | 10 (11.7) | |
120 kVp | 6 (7.0) | 4 (4.7) |
Evolocumab (n = 85) | Control (n = 85) | p value between groups | ||||||
---|---|---|---|---|---|---|---|---|
Baseline | Follow-up | p | Baseline | Follow-up | p | Baseline | Follow-up | |
Laboratory findingsa | ||||||||
TC (mmol/L) | 4.56 (2.78, 6.89) | 3.32 (2.18, 4.37) | < 0.001 | 4.48 (2.98, 6.69) | 3.81 (2.62, 5.89) | 0.052 | 0.914 | 0.016 |
HDL-C (mmol/L) | 1.38 (1.23, 1.65) | 1.41 (1.55, 1.80) | 0.869 | 1.32 (1.11, 1.52) | 1.35 (1.21, 1.62) | 0.301 | 0.622 | 0.099 |
LDL-C (mmol/L) | 3.34 (2.53, 4.14) | 2.02 (1.26, 2.78) | < 0.001 | 3.23 (2.54, 4.02) | 3.18 (2.63, 3.79) | 0.904 | 0.666 | < 0.001 |
TG (mmol/L) | 1.56 (1.23, 2.11) | 1.38 (1.13, 1.58) | 0.005 | 1.47 (1.28, 1.98) | 1.33 (1.13, 1.73) | 0.088 | 0.922 | 0.499 |
Lp(a) (mg/dL) | 18.9 (13.2, 27.2) | 12.1 (5.6, 21.8) | 0.002 | 17.6 (12.6, 27.5) | 18.9 (9.5, 28.2) | 0.918 | 0.650 | 0.001 |
HbA1c (%) | 6.6 (5.9, 7.3) | 6.8 (6.1, 7.4) | 0.473 | 6.7 (6.0, 7.4) | 6.9 (6.1, 7.4) | 0.472 | 0.376 | 0.443 |
CRP (mg/L) | 3.1 (1.9, 3.9) | 2.9 (2.5, 3.2) | 0.531 | 2.8 (1.9, 3.4) | 2.9 (2.4, 3.5) | 0.543 | 0.284 | 0.867 |
Medication in use, n (%) | ||||||||
ACEI/ARB | 49 (57.6) | 51 (60.0) | 0.876 | 47 (55.2) | 50 (58.8) | 0.756 | 0.877 | 1.000 |
β-Blocker | 33 (38.8) | 35 (41.1) | 0.875 | 35 (41.1) | 39 (45.9) | 0.642 | 0.875 | 0.643 |
Nitrates | 29 (34.1) | 31 (36.5) | 0.873 | 32 (37.6) | 36 (42.3) | 0.638 | 0.749 | 0.530 |
Baseline and follow-up laboratory findings
Baseline and follow-up CCTA parameters
Evolocumab (n = 85) | Control (n = 85) | p value between groups | ||||||
---|---|---|---|---|---|---|---|---|
Baseline | Follow-up | p | Baseline | Follow-up | p | Baseline | Follow-up | |
Total Agatston scorea | 178.2 (96.5, 344.6) | 251.5 (157.6, 384.0) | 0.057 | 214 (83.0, 421) | 228.1 (118.5, 424.2) | 0.536 | 0.900 | 0.333 |
Obstructive CAD, n (%) | 44 (51.8) | 30 (35.2) | 0.044 | 42 (49.4) | 39 (45.9) | 0.758 | 0.878 | 0.211 |
High-risk plaque features, n (%) | ||||||||
Low attenuation plaque | 33 (38.8) | 19 (22.3) | 0.031 | 37 (43.5) | 34 (40.0) | 0.755 | 0.640 | 0.020 |
Positive remodeling | 45 (52.9) | 31 (36.4) | 0.044 | 47 (55.2) | 42 (49.4) | 0.622 | 0.877 | 0.121 |
Spotty calcification | 15 (17.6) | 13 (15.3) | 0.836 | 16 (18.8) | 14 (16.4) | 0.840 | 1.000 | 1.000 |
Napkin-ring sign | 26 (30.1) | 16 (18.8) | 0.109 | 29 (34.1) | 22 (25.9) | 0.315 | 0.743 | 0.357 |
Atheroma volume (mm3)a | ||||||||
Total plaque volume | 223.4 (154.2, 573.7) | 289.2 (195.8, 582.3) | 0.194 | 218.4 (119. 3, 457.5) | 238.6 (172.7, 457.5) | 0.420 | 0.576 | 0.191 |
Calcified plaque volume | 129.3 (59.5, 238.3) | 188.3 (115.7, 361.0) | 0.015 | 103.5 (37.8, 233.5) | 126.0 (62.0, 214.5) | 0.097 | 0.281 | 0.030 |
Noncalcified plaque volume | 125.0 (65.3, 269.7) | 107.5 (40.6, 180.6) | 0.038 | 147.2 (70.3, 273.2) | 117.2 (55.0, 194.5) | 0.475 | 0.715 | 0.043 |
Necrotic volume | 0 (0, 13.4) | 0 (0, 4.7) | < 0.001 | 0 (0, 26.2) | 0 (0, 21.1) | 0.713 | 0.611 | 0.047 |
PCATRCA (HU)a | − 79.0 (− 83.5, − 74.0) | − 85.0 (− 89.0, − 82.0) | < 0.001 | − 79.0 (− 86.5, − 72.5) | − 81.0 (− 90.0, − 76.5) | 0.102 | 0.772 | 0.015 |
PCATLMT (HU)a | − 76.3 (− 80.6, − 71.3) | − 82.3 (− 86.3, − 79.2) | < 0.001 | − 75.4 (− 82.5, − 70.1) | − 78.7 (− 86.0, − 71.0) | 0.172 | 0.980 | 0.001 |
PCATLAD (HU)a | 76.9 (− 81.1, − 71.9) | − 83.1 (− 87.2, − 80.1) | < 0.001 | 76.3 (− 84.2, − 70.6) | 79.1 (− 87.4, − 72.5) | 0.076 | 0.773 | 0.013 |