TY - JOUR
T1 - Adverse cardiovascular events arising from atherosclerotic lesions with and without angiographic disease progression
AU - Sanidas, Elias A.
AU - Mintz, Gary S.
AU - Maehara, Akiko
AU - Cristea, Ecaterina
AU - Wennerblom, Bertil
AU - Iiguez, Andres
AU - Fajadet, Jean
AU - Fahy, Martin
AU - Dressler, Ovidiu
AU - Weisz, Giora
AU - Templin, Barry
AU - Zhang, Zhen
AU - Lansky, Alexandra J.
AU - De Bruyne, Bernard
AU - Serruys, Patrick
AU - Stone, Gregg W.
PY - 2012/3
Y1 - 2012/3
N2 - Objectives: The aim of this study was to use angiography and grayscale and intravascular ultrasoundvirtual histology to assess coronary lesions that caused events during a median follow-up period of 3.4 years. Background: Vulnerable plaque-related events are assumed to be the result of substantial progression of insignificant lesions. Methods: In the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study, 697 patients with acute coronary syndromes underwent treatment of all culprit lesions followed by 3-vessel imaging to assess the natural history of culprit and untreated nonculprit (NC) lesions. Future adverse cardiovascular events adjudicated to NC lesions were divided into those with versus without substantial lesion progression (SLP) (<20% angiographic diameter stenosis increase). Results: NC lesion events occurred in 72 patients, 44 (61%) with and 28 (39%) without SLP. Myocardial infarctions (n = 6) occurred only in patients with SLP. Conversely, patients without SLP presented only with unstable or increasing angina requiring rehospitalization. Lesions with versus without SLP occurred later (median time to event 401 vs. 223 days, p = 0.07); were less severe at baseline (median diameter stenosis 26.4% vs. 53.8%, p < 0.0001) but more severe at the time of the event (mean diameter stenosis 73.8% vs. 56%, p < 0.0001); and had comparable baseline median plaque burden (68.7% vs. 70.1%, p = 0.17), minimum luminal area (3.7 vs. 4.0 mm 2, p = 0.60), and intravascular ultrasoundvirtual histology phenotype (83.3% vs. 90.9%, p = 0.68; classified as fibroatheromas at baseline). Conclusions: NC lesions responsible for future cardiovascular events showed angiographic increase during 3.4 years of follow-up, whereas SLP underlay many but not all of them. NC events due to lesions with SLP were angiographically less severe and presented with a delayed time course but were otherwise indistinguishable from NC events that were not associated with SLP.
AB - Objectives: The aim of this study was to use angiography and grayscale and intravascular ultrasoundvirtual histology to assess coronary lesions that caused events during a median follow-up period of 3.4 years. Background: Vulnerable plaque-related events are assumed to be the result of substantial progression of insignificant lesions. Methods: In the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study, 697 patients with acute coronary syndromes underwent treatment of all culprit lesions followed by 3-vessel imaging to assess the natural history of culprit and untreated nonculprit (NC) lesions. Future adverse cardiovascular events adjudicated to NC lesions were divided into those with versus without substantial lesion progression (SLP) (<20% angiographic diameter stenosis increase). Results: NC lesion events occurred in 72 patients, 44 (61%) with and 28 (39%) without SLP. Myocardial infarctions (n = 6) occurred only in patients with SLP. Conversely, patients without SLP presented only with unstable or increasing angina requiring rehospitalization. Lesions with versus without SLP occurred later (median time to event 401 vs. 223 days, p = 0.07); were less severe at baseline (median diameter stenosis 26.4% vs. 53.8%, p < 0.0001) but more severe at the time of the event (mean diameter stenosis 73.8% vs. 56%, p < 0.0001); and had comparable baseline median plaque burden (68.7% vs. 70.1%, p = 0.17), minimum luminal area (3.7 vs. 4.0 mm 2, p = 0.60), and intravascular ultrasoundvirtual histology phenotype (83.3% vs. 90.9%, p = 0.68; classified as fibroatheromas at baseline). Conclusions: NC lesions responsible for future cardiovascular events showed angiographic increase during 3.4 years of follow-up, whereas SLP underlay many but not all of them. NC events due to lesions with SLP were angiographically less severe and presented with a delayed time course but were otherwise indistinguishable from NC events that were not associated with SLP.
KW - acute coronary syndromes
KW - intravascular ultrasound
KW - virtual histology
UR - https://www.scopus.com/pages/publications/84863338006
U2 - 10.1016/j.jcmg.2011.08.024
DO - 10.1016/j.jcmg.2011.08.024
M3 - Article
C2 - 22421236
AN - SCOPUS:84863338006
SN - 1936-878X
VL - 5
SP - S95-S105
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 3 SUPPL.
ER -
