Relation Between Angiographic Lesion Severity, Vulnerable Plaque Morphology and Future Adverse Cardiac Events (from the Providing Regional Observations to Study Predictors of Events in the Coronary Tree Study) - 26/07/12
Corresponding author: Tel: 646-434-4569; fax: 646-434-4464Résumé |
Previous angiographic studies have suggested that the future risk for major adverse cardiovascular events (MACEs) is related to coronary stenosis severity. The aim of this study was to use the grayscale and virtual histology (VH)–intravascular ultrasound (IVUS) data from the Providing Regional Observations to Study Predictors of Events in the Coronary Tree (PROSPECT) study to identify underlying lesion morphologic characteristics that might explain these findings. In PROSPECT, patients presenting with acute coronary syndromes in whom percutaneous coronary intervention was successful underwent 3-vessel grayscale and VH-IVUS and were followed for a median of 3.4 years for the incidence of MACEs. Overall, 3,115 nonculprit lesions detected by IVUS were divided into quartiles according to baseline angiographic diameter stenosis. From the first to fourth quartiles, there were increases in the prevalence of lesions with IVUS minimum luminal areas ≤4 mm2, IVUS plaque burden ≥70%, and VH-IVUS thin-cap fibroatheroma (13.4%, 22.0%, 24.2%, and 30.3%, respectively, p <0.001), along with an increased frequency of plaque ruptures and greater necrotic core volumes. The incidence of lesions with plaque burden ≥70%, minimum luminal area ≤4 mm2, and VH thin-cap fibroatheroma was highest in the fourth quartile (0%, 0.4%, 0.4%, and 2.8% in the first through fourth quartiles, respectively, p <0.001). Three-year MACE rates were also highest in the fourth quartile (0.3%, 0.7%, 1.3%, and 5.1%, respectively, p <0.001). In conclusion, increasing angiographic diameter stenosis was associated with an increased frequency of grayscale and VH-IVUS lesion morphologic features that have been associated with adverse events and that may, in part, explain why future MACEs were related to baseline lesion severity.
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| The Providing Regional Observations to Study Predictors of Events in the Coronary Tree (PROSPECT) study was funded by Abbott Vascular, Santa Clara, California, and funding was provided by Abbott Vascular and Volcano Corporation (Rancho Cordova, California). Dr. Yun has received grants from the Sung San Fellowship at Wonkwang University, Iksan, South Korea. Dr. Mintz has received research and grant support from Volcano Corporation and Boston Scientific Corporation, Natick, Massachusetts, and speaking honoraria from Boston Scientific Corporation. Dr. Mintz is a consultant for Volcano Corporation. Dr. Marso has received research grant support from Abbott Vascular; Boston Scientific Corporation; Volcano Corporation; and Terumo Medical, Somerset, New Jersey. Dr. Foster has received speaking honoraria from Volcano Corporation and Boston Scientific Corporation. Dr. Margolis is an employee of Volcano Corporation. Mr. Templin was an employee of Abbott Vascular. Dr. Stone is a consultant to Abbott Vascular; Boston Scientific Corporation; Medtronic, Inc., Minneapolis, Minnesota; Volcano Corporation; and InfraReDx, Burlington, Massachusetts. Dr. Maehara has received research grant support from Boston Scientific Corporation and speaking honoraria from Volcano Corporation. |
Vol 110 - N° 4
P. 471-477 - août 2012 Retour au numéro
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