ASSOCIATION BETWEEN HIGH-INTENSITY LIPID-LOWERING THERAPY AND ATHEROSCLEROTIC PLAQUE CONTENT CHANGES ASSESSED BY IMAP-IVUS AND NEAR-INFRARED SPECTROSCOPY IN PATIENTS WITH PREMATURE ATHEROSCLEROSIS

Background
The benefits of high-intensity lipid lowering therapy including PCSK9 inhibitors treatment have been well-established by randomized, controlled trials. Intravascular imaging such as near-infrared spectroscopy (NIRS) and iMAP-Intravascular ultrasound (iMAP-IVUS) can provide information about plaque composition. Our study aimed to evaluate plaque composition in very high cardiovascular risk patients receiving high-intensity lipid-lowering therapy.

Methods
In our study patients received statin and/or ezetimibe in maximum tolerated dose. If the LDL-C was >1.8 mmol/l, inclisiran was added to the therapy. After 15 months patients were classified in two groups – those who reached LDL-C target <1.8 mmol/L and those who did not. Plaque composition was assessed at the baseline and after 15 months.

Results
37 patients had undergone IVUS/NIRS investigation. After 15 months the mean LDL-C level decreased from 2.70 mmol/L to 1.79 mmol/l and 25 patients reached a target of <1.8 mmol/L. In the group that reached target – NIRS imaging LCBImax4mm decreased from 184.00 (±160.07) to 62.72 (±142.19) with p=0.001. In patients with LDL-C >1.8 mmol/L, LCBImax4mm changed from 211.16 (±167.76) to 125.04 (±152.21) with no statistically significant difference, p = 0.074. In iMAP-IVUS results necro-lipidic core in the <1.8 mmol/L group changed from 78.50 mm3 (±42.77) to 84.77 mm3 (±46.03), p = 0.422. Additionally, second group's necro-lipidic core changed from 97.43 mm3 (±58.04) to 89.40 mm3 (±49.03), with p = 0.066.

Conclusion
Our study showed that after 15 months of high-intensity lipid-lowering therapy patients who reached LDL-C levels <1.8 mmol/L, showed lower LCBImax4mm and total LCBI.