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General Thoracic and Cardiovascular Surgery

Published in:

01-06-2018 | Original Article

Suppressive effect of pitavastatin on aortic arch dilatation in acute stanford type B aortic dissection: analysis of STANP trial

Authors: Naoki Masaki, Kiichiro Kumagai, Konosuke Sasaki, Satoshi Matsuo, Naotaka Motoyoshi, Osamu Adachi, Masatoshi Akiyama, Shunsuke Kawamoto, Koichi Tabayashi, Yoshikatsu Saiki, For the STANP trial investigators

Published in: General Thoracic and Cardiovascular Surgery | Issue 6/2018

Abstract

Objectives

Medical therapy for patients with uncomplicated acute type B aortic dissection (ABAD) is essentially accepted for its excellent early outcome; however, long-term outcomes have not been satisfactory due to aorta-related complications. This trial was performed to investigate the efficacy of a statin as an additive that may enhance the effectiveness of conventional medical treatment in patients with ABAD.

Methods

This was a multi-center, prospective, and randomized comparative investigation of patients with uncomplicated ABAD. Fifty patients with ABAD compatible with inclusion criteria were randomly assigned to two groups and then received administration of pitavastatin (group P) or not (group C). We followed up the patients for 1 year from study onset.

Results

Two patients demised during the follow-up period (both were in group C). In addition, aorta-related interventions were performed in two patients (entry closure for aortic dissection by endovascular repair in one patient in each group). Aortic arch diameters at 1 year in group P tended to be smaller than in group C (P = 0.17), and the rate of change of the aortic arch diameters from onset to 1 year was significantly lower in group P (P = 0.046). Multivariate analysis identified patency of the false lumen was detected as a risk factor for aortic arch dilatation (P = 0.02), and pitavastatin intake was a negative risk factor (P = 0.03).

Conclusions

Pitavastatin treatment, in addition to the standard antihypertensive therapy, may have a suppressive effect on aortic arch dilatation in patients with ABAD.

Suzuki T, Isselbacher EM, Nienaber CA, Pyeritz RE, Eagle KA, Tsai TT, et al. Type-selective benefits of medications in treatment of acute aortic dissection (from the International Registry of Acute Aortic Dissection [IRAD]). Am J Cardiol. 2012;109:122–7.CrossRefPubMed

Durham CA, Cambria RP, Wang LJ, Ergul EA, Aranson NJ, Patel VI, et al. The natural history of medically managed acute type B aortic dissection. J Vasc Surg. 2015;61:1192–8.CrossRefPubMed

Akutsu K, Nejima J, Kiuchi K, Sasaki K, Ochi M, Tanaka K, et al. Effects of the patent false lumen on the long-term outcome of type B acute aortic dissection. Eur J Cardiothorac Surg. 2004;26:359–66.CrossRefPubMed

Suzuki T, Mehta RH, Ince H, Nagai R, Sakomura Y, Weber F, et al. Clinical profiles and outcomes of acute type B aortic dissection in the current era: lessons from the International Registry of Aortic Dissection (IRAD). Circulation. 2003;108(Suppl 1):Ii312–7.PubMed

Charilaou P, Ziganshin BA, Peterss S, Rajbanshi BG, Rajakaruna C, Zaza KJ, et al. Current experience with acute type B aortic dissection: validity of the complication-specific approach in the present era. Ann Thorac Surg. 2016;101:936–43.CrossRefPubMed

Genoni M, Paul M, Jenni R, Graves K, Seifert B, Turina M. Chronic beta-blocker therapy improves outcome and reduces treatment costs in chronic type B aortic dissection. Eur J Cardiothorac Surg. 2001;19:606–10.CrossRefPubMed

Takagi H, Matsui M, Umemoto T. A meta-analysis of clinical studies of statins for prevention of abdominal aortic aneurysm expansion. J Vasc Surg. 2010;52:1675–81.CrossRefPubMed

Raux M, Cochennec F, Becquemin JP. Statin therapy is associated with aneurysm sac regression after endovascular aortic repair. J Vasc Surg. 2012;55:1587–92.CrossRefPubMed

Sukhija R, Aronow WS, Sandhu R, Kakar P, Babu S. Mortality and size of abdominal aortic aneurysm at long-term follow-up of patients not treated surgically and treated with and without statins. Am J Cardiol. 2006;97:279–80.CrossRefPubMed

10.

Kalyanasundaram A, Elmore JR, Manazer JR, Golden A, Franklin DP, Galt SW, et al. Simvastatin suppresses experimental aortic aneurysm expansion. J Vasc Surg. 2006;43:117–24.CrossRefPubMed

11.

Steinmetz EF, Buckley C, Shames ML, Ennis TL, Vanvickle-Chavez SJ, Mao D, et al. Treatment with simvastatin suppresses the development of experimental abdominal aortic aneurysms in normal and hypercholesterolemic mice. Ann Surg. 2005;241:92–101.PubMedPubMedCentral

12.

Schneiderman J, Bordin GM, Adar R, Smolinsky A, Seiffert D, Engelberg I, et al. Patterns of expression of fibrinolytic genes and matrix metalloproteinase-9 in dissecting aortic aneurysms. Am J Pathol. 1998;152:703–10.PubMedPubMedCentral

13.

Zhang X, Shen YH, LeMaire SA. Thoracic aortic dissection: are matrix metalloproteinases involved? Vascular. 2009;17:147–57.CrossRefPubMedPubMedCentral

14.

Akiyama M, Ohtani H, Sato E, Nagura H, Tabayashi K. Up-regulation of matrix metalloproteinase-2 and membrane-type 1-matrix metalloproteinase were coupled with that of type I procollagen in granulation tissue response after the onset of aortic dissection. Virchows Arch. 2006;448:811–21.CrossRefPubMed

15.

Yoshida O, Kondo T, Kureishi-Bando Y, Sugiura T, Maeda K, Okumura K, et al. Pitavastatin, an HMG-CoA reductase inhibitor, ameliorates endothelial function in chronic smokers. Circ J. 2010;74:195–202.CrossRefPubMed

16.

Jia LX, Zhang WM, Li TT, Liu Y, Piao CM, Ma YC, et al. ER stress dependent microparticles derived from smooth muscle cells promote endothelial dysfunction during thoracic aortic aneurysm and dissection. Clin Sci (Lond). 2017;131:1287–99.CrossRef

17.

Kamman AV, Brunkwall J, Verhoeven EL, Heijmen RH, Trimarchi S. Predictors of aortic growth in uncomplicated type B aortic dissection from the acute dissection stent grafting or best medical treatment (ADSORB) database. J Vasc Surg. 2017;65:964–71.e3.CrossRefPubMed

18.

Grubb BP, Sirio C, Zelis R. Intravenous labetalol in acute aortic dissection. JAMA. 1987;258:78–9.CrossRefPubMed

19.

Shores J, Berger KR, Murphy EA, Pyeritz RE. Progression of aortic dilatation and the benefit of long-term beta-adrenergic blockade in Marfan’s syndrome. N Engl J Med. 1994;330:1335–41.CrossRefPubMed

20.

Kodama K, Nishigami K, Sakamoto T, Sawamura T, Hirayama T, Misumi H, et al. Tight heart rate control reduces secondary adverse events in patients with type B acute aortic dissection. Circulation. 2008;118:S167–70.CrossRefPubMed

21.

Takeshita S, Sakamoto S, Kitada S, Akutsu K, Hashimoto H. Angiotensin-converting enzyme inhibitors reduce long-term aortic events in patients with acute type B aortic dissection. Circ J. 2008;72:1758–61.CrossRefPubMed

22.

Hackam DG, Thiruchelvam D, Redelmeier DA. Angiotensin-converting enzyme inhibitors and aortic rupture: a population-based case-control study. Lancet. 2006;368:659–65.CrossRefPubMed

23.

Nienaber CA, Kische S, Rousseau H, Eggebrecht H, Rehders TC, Kundt G, et al. Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial. Circ Cardiovasc Interv. 2013;6:407–16.CrossRefPubMed

24.

Nienaber CA, Rousseau H, Eggebrecht H, Kische S, Fattori R, Rehders TC, et al. Randomized comparison of strategies for type B aortic dissection: the investigation of stent grafts in aortic dissection (INSTEAD) trial. Circulation. 2009;120:2519–28.CrossRefPubMed

25.

Brunkwall J, Lammer J, Verhoeven E, Taylor P. ADSORB: a study on the efficacy of endovascular grafting in uncomplicated acute dissection of the descending aorta. Eur J Vasc Endovasc Surg. 2012;44:31–6.CrossRefPubMed

26.

Hughes GC. Management of acute type B aortic dissection; ADSORB trial. J Thorac Cardiovasc Surg. 2015;149:S158-162.CrossRef

27.

Coselli JS, Spiliotopoulos K, Preventza O, de la Cruz KI, Amarasekara H, Green SY. Open aortic surgery after thoracic endovascular aortic repair. Gen Thorac Cardiovasc Surg. 2016;64:441–9.CrossRefPubMed

28.

van Bogerijen GH, Tolenaar JL, Rampoldi V, Moll FL, van Herwaarden JA, Jonker FH, et al. Predictors of aortic growth in uncomplicated type B aortic dissection. J Vasc Surg. 2014;59:1134–43.CrossRefPubMed

29.

Jonker FH, Trimarchi S, Rampoldi V, Patel HJ, O’Gara P, Peterson MD, et al. Aortic expansion after acute type B aortic dissection. Ann Thorac Surg. 2012;94:1223–9.CrossRefPubMed

30.

Matsuda H. Treatment of uncomplicated type B aortic dissection. Gen Thorac Cardiovasc Surg. 2017;65:74–9.CrossRefPubMed

Title: Suppressive effect of pitavastatin on aortic arch dilatation in acute stanford type B aortic dissection: analysis of STANP trial
Authors: Naoki Masaki
Kiichiro Kumagai
Konosuke Sasaki
Satoshi Matsuo
Naotaka Motoyoshi
Osamu Adachi
Masatoshi Akiyama
Shunsuke Kawamoto
Koichi Tabayashi
Yoshikatsu Saiki
For the STANP trial investigators
Publication date: 01-06-2018
Publisher: Springer Japan
Published in: General Thoracic and Cardiovascular Surgery / Issue 6/2018
Print ISSN: 1863-6705
Electronic ISSN: 1863-6713
DOI: https://doi.org/10.1007/s11748-018-0916-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Suppressive effect of pitavastatin on aortic arch dilatation in acute stanford type B aortic dissection: analysis of STANP trial

Abstract

Objectives

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

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