{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:30:19Z","timestamp":1792024219603,"version":"4.4.0"},"reference-count":28,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Cardiol"],"published-print":{"date-parts":[[2024,12,1]]},"abstract":"\n Importance<\/jats:title>\n Previous studies investigated atherosclerotic changes induced by lipid-lowering therapy in extensive coronary segments irrespective of baseline disease burden (a vessel-level approach).<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To investigate the effects of lipid-lowering therapy on coronary lesions with advanced atherosclerotic plaque features and presumably higher risk for future events.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n The PACMAN-AMI randomized clinical trial (enrollment: May 2017 to October 2020; final follow-up: October 2021) randomized patients with acute myocardial infarction to receive alirocumab or placebo in addition to high-intensity statin therapy. In this post hoc lesion-level analysis, nonculprit lesions were identified as segments with plaque burden 40% or greater defined by intravascular ultrasound (IVUS). IVUS, near-infrared spectroscopy, and optical coherence tomography images at baseline and the 52-week follow-up were manually matched by readers blinded to treatment allocation. Data for this study were analyzed from October 2022 to November 2023.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Alirocumab or placebo in addition to high-intensity statin therapy.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Lesion-level imaging outcome measures, including high-risk plaque characteristics and phenotypes.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of the 245 patients in whom lesions were found, 118 were in the alirocumab group (mean [SD] age, 58.2 [10.0] years; 101 [85.6%] male and 17 [14.4%] female) and 127 in the placebo group (mean [SD] age, 57.7 [8.8] years; 104 [81.9%] male and 23 [18.1%] female). Overall, 591 lesions were included: 287 lesions (118 patients, 214 vessels) in the alirocumab group and 304 lesions (127 patients, 239 vessels) in the placebo group. Lesion-level mean change in percent atheroma volume (PAV) was \u22124.86% with alirocumab vs \u22122.78% with placebo (difference, \u22122.02; 95% CI, \u22123.00 to \u22121.05;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). At the minimum lumen area (MLA) site, mean change in PAV was \u221210.14% with alirocumab vs \u22126.70% with placebo (difference, \u22123.36; 95% CI, \u22124.98 to \u22121.75;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). MLA increased by 0.15 mm\n 2<\/jats:sup>\n with alirocumab and decreased by 0.07 mm\n 2<\/jats:sup>\n with placebo (difference, 0.21; 95% CI, 0.01 to 0.41;\n P<\/jats:italic>\n \u2009=\u2009.04). Among 122 lipid-rich lesions, 34 of 55 (61.8%) in the alirocumab arm and 27 of 67 (41.8%) in the placebo arm showed a less lipid-rich plaque phenotype at follow-up (\n P<\/jats:italic>\n \u2009=\u2009.03). Among 63 lesions with thin-cap fibroatheroma at baseline, 8 of 26 (30.8%) in the alirocumab arm and 3 of 37 (8.1%) in the placebo arm showed a fibrous\/fibrocalcific plaque phenotype at follow-up (\n P<\/jats:italic>\n \u2009=\u2009.02).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT03067844<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamacardio.2024.3200","type":"journal-article","created":{"date-parts":[[2024,9,2]],"date-time":"2024-09-02T05:31:04Z","timestamp":1725255064000},"page":"1082","source":"Crossref","is-referenced-by-count":42,"title":["Lesion-Level Effects of LDL-C\u2013Lowering Therapy in Patients With Acute Myocardial Infarction"],"prefix":"10.1001","volume":"9","author":[{"given":"Flavio G.","family":"Biccir\u00e8","sequence":"first","affiliation":[{"name":"Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryota","family":"Kakizaki","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos C.","family":"Koskinas","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasushi","family":"Ueki","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"H\u00e4ner","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroki","family":"Shibutani","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"L\u00f8nborg","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernest","family":"Spitzer","sequence":"additional","affiliation":[{"name":"Cardialysis, Rotterdam, the Netherlands"},{"name":"Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan F.","family":"Iglesias","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Geneva University Hospital, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsuhiko","family":"Otsuka","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George C. 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