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Statin and Atheroma Vulnerability Evaluation (STABLE)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00997880
Recruitment Status : Completed
First Posted : October 19, 2009
Last Update Posted : December 25, 2014
CardioVascular Research Foundation, Korea
Information provided by (Responsible Party):
Seung-Jung Park, CardioVascular Research Foundation, Korea

Brief Summary:
The purpose of this study is to evaluate the effect of statin therapy on the modification of atherosclerotic plaque composition and vulnerability in non-intervened coronary arteries with mild to moderate stenosis using VH-IVUS and OCT.

Condition or disease Intervention/treatment Phase
Coronary Artery Disease Drug: Rosuvastatin calcium 40mg Drug: Rosuvastatin calcium10mg Phase 4

Detailed Description:

At present, there is no proven drug or modality to stabilize the vulnerable plaques. A number of drugs that are beneficial for patients with coronary disease may act in part by improving the stability of plaques that are vulnerable for future rupture. Especially, Lipid-lowering therapy, particularly with statins, can stabilize vulnerable plaques or those that have already ruptured by improving endothelial function and reducing thrombogenicity, platelet aggregation, and possibly inflammation. As the atherosclerotic disease has progressed, there is an increase of the atherosclerotic plaque amounts. However, the changes of specific plaque compositions within the atherosclerotic lesions have not been sufficiently evaluated. Previous pathologic findings reported that there was a significant relation between the plaque size and necrotic core size.Conventional grey-scale intravascular ultrasound (IVUS) has significant limitations in accurately assessing atheromatous plaque composition. These limitations have been partially addressed by radiofrequency signal processing with spectral analysis of the back-scattered ultrasound signals. Using this technology, Virtual Histology (VH) IVUS is capable of characterizing plaque as calcified (white), fibrotic (dark-green), fibrofatty (yellow-green), and necrotic core (red). In addition, optical coherence tomography (OCT) is a light-based imaging modality that can be used in biological systems to study tissues in vivo with near-histologic, ultrahigh resolution. The rationale for intravascular application of OCT is its potential for in vivo visualizations of the coronary artery microstructure. This unique image resolution of OCT offers the potential to detect key features of vulnerable plaque in vivo. Beyond the inherent limitations of angioscopy and intravascular ultrasound, OCT might offer a much higher sensitivity in the detection of necrotic/lipid cores within coronary atheromas. Therefore, plaque characterization using VH-IVUS and OCT may provide detailed morphologic insights of plaque vulnerability.

We hypothesized that statin would provide benefits to stabilize coronary plaque composition by LDL-reduction and/or a pleiotropic effect. We also hypothesized that high-dose statin would be more beneficial in reducing the vulnerable plaque and stabilizing the vulnerable plaque composition than low-dose statin.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 312 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Effect of High-Dose and Low-Dose Statin for Coronary Plaque Modification
Study Start Date : April 2010
Actual Primary Completion Date : December 2014
Actual Study Completion Date : December 2014

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: Rosuvastatin calcium 40mg
high-dose (40mg rosuvastatin)
Drug: Rosuvastatin calcium 40mg
Rosuvastatin calcium 40mg
Other Name: CRESTOR® 40mg

Active Comparator: Rosuvastatin calcium10mg
low-dose statin (10mg rosuvastatin)
Drug: Rosuvastatin calcium10mg
Rosuvastatin 10mg
Other Name: CRESTOR® 10mg

Primary Outcome Measures :
  1. Percent compositional change of coronary plaque in the entire pullback length Percent compositional c Percent hange of coronary plaque in the entire pullback length of "target segment" (within both proximal and distal fiduciary sites) [ Time Frame: 12months ]

Secondary Outcome Measures :
  1. VH-IVUS parameters [ Time Frame: 12months ]
  2. Conventional IVUS parameters [ Time Frame: 12months ]
  3. OCT Sub-study parameters [ Time Frame: 12months ]
  4. Serum biomarkers [ Time Frame: 12months ]

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Male or female at least 18 years of age inclusive.
  2. Patients with stable (CCS class 1 to 4) or acute coronary syndromes (unstable angina pectoris Braunwald class IB, IC, IIB, IIC, IIIB, IIIC or NSTEMI) or patients with atypical chest pain or without symptoms but having documented myocardial ischemia who will undergo either planned coronary angiography, or percutaneous coronary intervention
  3. Non-culprit de novo lesion in a native coronary artery with at least one deferred coronary lesion with 1) visually-estimated angiographic % diameter stenosis 20-50% or 2) % diameter stenosis >50% without any evidence of inducible ischemia (FFR≥0.8 or negative perfusion on thiallium scan or negative treadmill test). Index lesion should have at least 1 fibroatheroma or TCFA.
  4. The patient or guardian agrees to the study protocol and the schedule of clinical and angiographic follow-up, and provides informed, written consent, as approved by the appropriate Institutional Review Board/Ethical Committee of the respective clinical site

Exclusion Criteria:

  1. Planned cardiac surgery (e.g., CABG, valve repair or replacement, or aneurysmectomy) or planned major non-cardiac surgery within the study period
  2. Stroke or resuscitated sudden death in the past 6 months
  3. Chronic disease requiring treatment with oral, intravenous, or intra-articular corticosteroids (use of topical, inhaled, or nasal corticosteroids is permissible)
  4. Untreated hyperthyroidism, or hypothyroidism with TSH levels more than 1.5 times upper limit of normal
  5. A diagnosis of cancer (other than superficial squamous or basal cell skin cancer) in the past 3 years or current treatment for the active cancer
  6. Any clinically significant abnormality identified at the screening visit, physical examination, laboratory tests, or electrocardiogram which, in the judgment of the Investigator, would preclude safe completion of the study
  7. Evidence of congestive heart failure, or left ventricular ejection fraction < 40%
  8. Significant renal disease manifested by serum creatinine > 2.0mg/dL, or creatinine clearance of < 40 ml/min (by Cockcroft-Gault method)
  9. Hepatic disease or biliary tract obstruction, or significant hepatic enzyme elevation (ALT or AST > 3 times upper limit of normal)
  10. History of myopathy or elevated creatine kinase (CK) > 3 times upper normal limit at screening
  11. History of adult asthma manifested by bronchospasm in the past 6 months, or currently taking regular anti-asthmatic medication(s)
  12. Unwillingness or inability to comply with the procedures described in this protocol
  13. History of any arterial bypass or angioplastic intervention involving the target vessel
  14. The luminal narrowing in the target vessel or in the left main coronary artery >50% by visual inspection of angiogram
  15. Luminal diameter of the target vessel < 2.5mm by visual inspection of coronary angiogram
  16. Presence of thrombus or complex plaque morphology in the target vessel that suggests a high likelihood of distal embolism
  17. Severe tortuosity of the target vessel or any other anatomical reasons that the investigator deems inappropriate for IVUS procedures

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00997880

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Korea, Republic of
Asan Medical Center
Seoul, Republic of Korea, Korea, Republic of, 138-736
Sponsors and Collaborators
Seung-Jung Park
CardioVascular Research Foundation, Korea
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Principal Investigator: Seung-Jung Park, MD,PhD Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine
Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: Seung-Jung Park, M.D., Ph.D.,Professor of Medicine Asan Medical Center, University of Ulsan, College of Medicine, CardioVascular Research Foundation, Korea Identifier: NCT00997880    
Other Study ID Numbers: 2008-0361
First Posted: October 19, 2009    Key Record Dates
Last Update Posted: December 25, 2014
Last Verified: December 2014
Keywords provided by Seung-Jung Park, CardioVascular Research Foundation, Korea:
Additional relevant MeSH terms:
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Coronary Artery Disease
Coronary Disease
Myocardial Ischemia
Heart Diseases
Cardiovascular Diseases
Arterial Occlusive Diseases
Vascular Diseases
Calcium, Dietary
Rosuvastatin Calcium
Calcium-Regulating Hormones and Agents
Physiological Effects of Drugs
Bone Density Conservation Agents
Anticholesteremic Agents
Hypolipidemic Agents
Molecular Mechanisms of Pharmacological Action
Lipid Regulating Agents
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Enzyme Inhibitors