Effect of sitagliptin on plaque changes in coronary artery following acute coronary syndrome in diabetic patients: The ESPECIAL-ACS study

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• 作者：Shoichi Kuramitsu ; MD^a ; ^{kuramitsu@circulation.jp} ; Katsumi Miyauchi ; MD ; FJCC^b ; Hiroyoshi Yokoi ; MD^c ; Satoru Suwa ; MD^d ; Yuji Nishizaki ; MD ; PhD ; MPH^b ; Takayuki Yokoyama ; MD ; PhD^b ; Shuko Nojiri ; PhD^b ; Masashi Iwabuchi ; MD^e ; Shinichi Shirai ; MD^f ; Kenji Ando ; MD^a ; Shinya Okazaki ; MD^b ; Hiroshi Tamura ; MD^b ; Hirotaka Watada ; MD ; PhD^f ; Hiroyuki Daida ; MD ; FJCC^b
• 关键词：Dipeptidyl-peptidase IV inhibitors ; Acute coronary syndrome ; Diabetes mellitus ; Integrated backscatter intravascular ultrasound
• 刊名：Journal of Cardiology
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：69
• 期：1
• 页码：369-376
• 全文大小：961 K
• 卷排序：69

文摘

Dipeptidyl peptidase-4 (DPP-4) inhibitors have anti-atherosclerotic and cardioprotective effects in vitro. However, the impact of DPP-4 inhibitors on coronary plaque remains unclear. We sought to assess the effect of sitagliptin on coronary plaque volume (PV) and stabilization in diabetic patients with acute coronary syndrome (ACS).MethodsThe ESPECIAL-ACS was a prospective, randomized, open-label, parallel group study at 4 Japanese centers to assess the effect of 6-month treatment with sitagliptin on coronary plaque changes in non-culprit lesion in diabetic patients with ACS using serial intravascular ultrasound (IVUS) and integrated backscatter IVUS (IB-IVUS) analysis.ResultsA total of 41 patients were randomly allocated to either sitagliptin group (diet and exercise with sitagliptin 50–100 mg daily, n = 21) or control group (diet and exercise, n = 20) within 72 h after percutaneous coronary intervention, and underwent volumetric IVUS and IB-IVUS analyses at baseline and 6-month follow-up. At 6-month follow-up, the percent change in PV as primary endpoint was larger in the sitagliptin group than in the control group, but the difference was not statistically significant (−4.0 ± 8.5% vs. −1.4 ± 8.8%, p = 0.35). In IB-IVUS analysis, the percent change in lipid PV significantly decreased in the sitagliptin group compared with the control group (−7.1 ± 21.5% vs. 15.6 ± 41.8%, p = 0.03).ConclusionsCompared with diet and exercise therapy, sitagliptin did not significantly reduce coronary PV in diabetic patients with ACS at 6-month follow-up. However, the percent change in lipid PV significantly decreased in the sitagliptin group, suggesting that sitagliptin has a potential to stabilize the plaque vulnerability.