To Evaluate The Efficacy Of Statins On Coronary Artery Plaque By 320-slice Computed Tomography,and Further Explore The Influence Factors Of The Efficacy

BackgroundCoronary atherosclerotic heart disease(CAD)has become one of the major diseases endangering human health in the world.Its main pathological basis is coronary artery sclerosis and plaque formation,coronary artery sclerosis is lipid metabolism disorder and inflammatory vascular disease,a large number of studies confirmed that statins are the cornerstone of primary and secondary prophylaxis of coronary heart disease.It not only has many effects,such as regulating blood lipid,repairing damaged endothelium,antagonizing inflammation,antioxidation,improving endothelial function,but also stabilizing and reversing coronary atherosclerotic plaque,so statins are widely used in clinic.In order to better observe the effect of statins on coronary atherosclerotic plaque and its influencing factors,some intravascular imaging examinations such as intravascular ultrasound(IVUSU),coronary computed tomographic angiography(CCTA)and coronary arteriography(CAG)were used in clinical practice.However,the expensive and invasive nature of IVUS and CAG limits the scope and quantity of their application.Because of the continuous innovation of CCTA technology,320-slice spiral CT is now very common,and its diagnostic accuracy for coronary heart disease has been improved significantly,which can better serve the clinical and scientific research work.Objective1.To evaluate the efficacy of statins on different types of coronary artery plaque by 320-slice computed tomography;2.To further explore the influence factors of the efficacy of statins in ameliorating the coronary artery plaque.Methods Subjects were randomly selected from January 2014 to January 2018 in Guangzhou No.1 People's Hospital for 2 times or more CCTA examination of hospitalized patients,and the 2 times CCTA examination interval is not less than 1 year,and after strict selection criteria and exclusion criteria screening,123 patients were collected.The basic situation of the patients,two coronary lesions and blood lipids,the use of statins and the occurrence of adverse events were recorded.2.the study group: According to the first CCTA results,all the selected patients were screened out of the target B plaques.The subjects were divided into three groups(Group I,progressive group n=32,Group II,stable group n=40,Group III,exacerbated group n=30)according to the target B plaque location of coronary artery stenosis between the two CCTA examination.Results In this study,123 patients with coronary atherosclerosis were examined by CCTA and reviewed with CCTA after taking statins regularly for more than a year.Among them,73 were males and 50 were females,aged 43~86 years,with an average age of 67.19 ±11.20 years.The results showed that the levels of LDL-C,TG in patients treated with statins were significantly lower than those before treatment.After taking statins regularly,the total calcification score and the degree of coronary artery stenosis at the location of target A plaque(calcified plaque)were significantly exacerbated compared with those before treatment.However,the degree of coronary artery stenosis at the location of target B plaque(non-calcified plaque or mixed plaque)was significantly improved after treatment,and there were statistically significant differences among the three groups(P < 0.05).At the same time,102 patients who met the target B plaque criteria(i.e.,non-calcified plaques and mixed plaques)were included in this study.The subjects were divided into three groups(Group I,progressive group n=32,Group II,stable group n=40,Group III,exacerbated group n=30)according to the target B plaque location of coronary artery stenosis between the two CCTA examination.It was found that there was no statistical difference in the general conditions of the three groups,such as age,sex,drinking history,history of basic diseases,but there was significant difference in body mass index(BMI)and smoking history among the three groups(P < 0.05).In addition,there was statistical difference between the three groups in the basic level of LDL-C and the basic level of TC before entering the group.There were significant differences between the two indexes of LDL-C basic level and TC basic level between the exacerbated group and the progressive group.The basic level of LDL-C was significantly different between the stable group and the exacerbated group(P < 0.05).Before and after treatment with statins,the level of serum lipids decreased,that is,LDL-C and TC were significantly different among the three groups.And there was significant difference between the exacerbated group and progressive group,as well as stable group and exacerbated group.That is,the more obvious the decrease of LDL-C,TC after statin treatment,the more obvious the reversal effect of atherosclerotic plaque.The main adverse cardiovascular events(main adverse cardiovascular events)were recorded by the medical record system and telephone follow-up.No significant difference was found between the three groups in MACE and readmission rate due to cardiovascular events.Conclusion 1.Long-term regular administration of statins can significantly improve the non-calcified plaques in coronary atherosclerosis,while the calcification progression of calcified plaques does not improve.2.The factors such as male,smoking,obesity,low LDL-C before treatment,low TC level and low density of LDL-C and TC after statin therapy significantly affect the efficacy of statins in reversing non-calcified plaques.