Virtual Histology Findings and Effects of Varying Doses of Atorvastatin Treatment

NCT ID: NCT01200056

Last Updated: 2013-02-28

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

40 participants

Study Classification

INTERVENTIONAL

Study Start Date

2007-08-31

Study Completion Date

2010-06-30

Brief Summary

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While statin treatment may induce plaque regression, the effect of statin on plaque composition with varying doses is unknown. This study assessed such effects by volumetric virtual histology intravascular ultrasound (VH-IVUS).

In this prospective, randomized, double-blinded pilot study, statin-naïve patients with stable angina requiring percutaneous coronary intervention (PCI) were randomized to receive 6 months of either atorvastatin 10mg or 40 mg daily. VH-IVUS was performed in all non-PCI lesions at baseline and 6 months; all analyses were performed by core laboratory.

Detailed Description

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Statin therapy, especially at intensive doses, is beneficial in atherosclerotic coronary disease. Detecting subtle plaque regression after statin therapy is difficult by coronary angiogram; intravascular ultrasound (IVUS) is a far better method. Volumetric IVUS has been used in statin trials to evaluate plaque regression. Intensive statin therapy in the REVERSAL Trial and ASTEROID Trial appeared to achieve better regression outcomes. Stable fibrous plaque is likely to be responsible for stable ischemia, while unstable plaque (large lipid core, calcified nodule and necrotic core), thin-cap fibroatheroma, plaque erosion and plaque rupture may be responsible for acute coronary syndrome (ACS). In vivo tissue characterization of plaque composition is therefore important, yet in this regard grayscale IVUS is insufficient. The development of Virtual Histology (VH) utilizing IVUS generated radiofrequency backscattering signals to virtually separate plaque composition into 4 components corresponding to histopathology has made possible in vivo assessment of plaque composition and stability. We believed plaque regression and VH-IVUS plaque modification with statin therapy could be statin dose dependent, and may affect clinical outcomes. This study was designed to prove our hypothesis, utilizing VH-IVUS.

This study is the first prospective, randomised, double-blinded pilot study designed to investigate the varying statin dose effects on plaque regression and VH composition modulation. For ethical reasons, a placebo arm was not designed. Based on available data, clinically realistic doses of atorvastatin 10mg (low dose) and 40mg (moderate dose) were chosen. Only statin-naïve patients without previous history of myocardial infarction (MI) would be selected, aiming to show the "pure" effects of varying doses of statin and to better reveal the subtle differences in the changes.

Conditions

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Coronary Disease Ultrasonography, Interventional Hydroxymethylglutaryl-CoA Reductase Inhibitors

Keywords

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Volumetric virtual histology intravascular ultrasound. Statin-naive patient. Varying doses atorvastatin. Clinical outcomes.

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Atorvastatin 10mg low dose

Atorvastatin 10mg daily for 6 months and compared to atorvastatin 40mg daily in the other arm. The primary endpoint of 6 months VH-IVUS findings and clinical outcomes would be monitored and compared.

Group Type ACTIVE_COMPARATOR

Atorvastatin 10mg versus 40mg.

Intervention Type DRUG

2 arms comparing atorvastatin 10mg daily for 6 months to atorvastatin 40mg daily for 6 months. The primary endpoint would be the 6 months VH-IVUS findings and clinical outcomes.

Atorvastatin 40mg moderate dose

Atorvastatin 40mg daily for 6 months and compared to atorvastatin 10mg daily in the other arm. The primary endpoint of 6 months VH-IVUS findings and clinical outcomes would be monitored and compared.

Group Type ACTIVE_COMPARATOR

Atorvastatin 10mg versus 40mg.

Intervention Type DRUG

2 arms comparing atorvastatin 10mg daily for 6 months to atorvastatin 40mg daily for 6 months. The primary endpoint would be the 6 months VH-IVUS findings and clinical outcomes.

Interventions

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Atorvastatin 10mg versus 40mg.

2 arms comparing atorvastatin 10mg daily for 6 months to atorvastatin 40mg daily for 6 months. The primary endpoint would be the 6 months VH-IVUS findings and clinical outcomes.

Intervention Type DRUG

Other Intervention Names

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Lipitor 10mg versus 40mg daily for 6 months.

Eligibility Criteria

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Inclusion Criteria

* Patient aged 18 to 85 (not pregnant) requiring percutaneous intervention to coronary stenosis.
* Statin naive patient.
* No history of myocardial infarction. Angina free for at least 8 weeks.

Exclusion Criteria

* Any history of previous statin treatment and myocardial infarction
* Current acute coronary syndrome or in cardiogenic shock
* Surgical bypass candidate
* Chronic total occlusion and very tortuous calcified arteries precluding safe IVUS examination.
* Patient refused to give written informed consent.
Minimum Eligible Age

18 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Queen Mary Hospital, Hong Kong

OTHER

Sponsor Role collaborator

Pfizer

INDUSTRY

Sponsor Role collaborator

Prof. Stephen Lee

OTHER

Sponsor Role lead

Responsible Party

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Prof. Stephen Lee

Professor and Chief

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Prof. Stephen WL LEE, MD FRCP FACC

Role: PRINCIPAL_INVESTIGATOR

Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hospital Authority

Locations

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Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hospital Authority

Hong Kong SAR, Hong Kong, China

Site Status

Countries

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China

References

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Other Identifiers

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HKCTR-517

Identifier Type: OTHER

Identifier Source: secondary_id

UW 07-266 (IRB HKU)

Identifier Type: -

Identifier Source: org_study_id