TY - JOUR
T1 - Residual plaque burden in patients with acute coronary syndromes after successful percutaneous coronary intervention
AU - McPherson, John A.
AU - Maehara, Akiko
AU - Weisz, Giora
AU - Mintz, Gary S.
AU - Cristea, Ecaterina
AU - Mehran, Roxana
AU - Foster, Michael
AU - Verheye, Stefan
AU - Rabbani, Leroy
AU - Xu, Ke
AU - Fahy, Martin
AU - Templin, Barry
AU - Zhang, Zhen
AU - Lansky, Alexandra J.
AU - De Bruyne, Bernard
AU - Serruys, Patrick W.
AU - Stone, Gregg W.
N1 - Funding Information:
This work was sponsored by Abbott Vascular and funded by Abbott Vascular and Volcano Corporation. Dr. McPherson is a consultant for Abbott Vascular. Dr. Maehara has received research grant support from Boston Scientific , and speaker honoraria from Volcano Corporation. Dr. Mintz has received research grant support from and is a consultant for Volcano Corporation , and research grant support and honoraria from Boston Scientific . Dr. Mehran is a consultant for AstraZeneca; and is on the advisory boards of Ortho McNeil-Janssen and Regado Biosciences. Dr. Foster has received honoraria from Volcano Corporation and Boston Scientific. Mr. Templin and Dr. Zhang are employees of Abbott Vascular. Dr. Stone is a consultant to Medtronic, Boston Scientific, Abbott Vascular, Volcano Corporation, and InfraReDx. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
PY - 2012/3
Y1 - 2012/3
N2 - Objectives: The aim of this study was to characterize and evaluate the clinical impact of untreated atherosclerotic disease after percutaneous coronary intervention (PCI) in patients with acute coronary syndromes (ACS). Background: Residual atherosclerotic disease after successful PCI may predispose future major adverse cardiovascular events (MACE). Compared with intravascular ultrasound (IVUS), angiography underestimates the presence and severity of coronary artery disease. Methods: Following successful PCI of all clinically significant lesions in 697 patients with ACS, 3-vessel grayscale and radiofrequency IVUS was performed. Lesions were prospectively characterized, and patients were followed for a median of 3.4 years. A total of 3,229 untreated lesions (4.89 ± 1.98 lesions/patient) were identified by IVUS, with mean plaque burden (PB) of 49.6 ± 4.2%. Results: By angiography these nonculprit lesions were mild, with mean diameter stenosis of 38.9 ± 15.3%. At least 1 lesion with a PB <70% (PB70 lesion) was found in 220 (33%) patients. By multivariable analysis, a history of prior PCI and angiographic 3-vessel disease were independent predictors of PB70 lesions. Patients with PB70 lesions had greater total percent plaque volume, normalized PB, fibroatheromas, thin-cap fibroatheromas, and normalized volumes of necrotic core and dense calcium. Patients with PB70 lesions had greater 3-year rates of MACE due to untreated nonculprit lesions (20.8% vs. 7.7%, p < 0.0001). Among imaged nonculprit lesions, the proportion of PB70 lesions causing MACE was significantly greater than non-PB70 lesions (8.7% vs. 1.0%, p < 0.0001). Conclusions: After successful PCI of all angiographically significant lesions, overall untreated atherosclerotic burden remains high, and PB70 lesions are frequently present in the proximal and mid-coronary tree. Patients with PB70 lesions have greater atherosclerosis throughout the coronary tree, have more thin-cap fibroatheromas, and are at increased risk for future cardiovascular events. (PROSPECT: An Imaging Study in Patients With Unstable Atherosclerotic Lesions; NCT00180466)
AB - Objectives: The aim of this study was to characterize and evaluate the clinical impact of untreated atherosclerotic disease after percutaneous coronary intervention (PCI) in patients with acute coronary syndromes (ACS). Background: Residual atherosclerotic disease after successful PCI may predispose future major adverse cardiovascular events (MACE). Compared with intravascular ultrasound (IVUS), angiography underestimates the presence and severity of coronary artery disease. Methods: Following successful PCI of all clinically significant lesions in 697 patients with ACS, 3-vessel grayscale and radiofrequency IVUS was performed. Lesions were prospectively characterized, and patients were followed for a median of 3.4 years. A total of 3,229 untreated lesions (4.89 ± 1.98 lesions/patient) were identified by IVUS, with mean plaque burden (PB) of 49.6 ± 4.2%. Results: By angiography these nonculprit lesions were mild, with mean diameter stenosis of 38.9 ± 15.3%. At least 1 lesion with a PB <70% (PB70 lesion) was found in 220 (33%) patients. By multivariable analysis, a history of prior PCI and angiographic 3-vessel disease were independent predictors of PB70 lesions. Patients with PB70 lesions had greater total percent plaque volume, normalized PB, fibroatheromas, thin-cap fibroatheromas, and normalized volumes of necrotic core and dense calcium. Patients with PB70 lesions had greater 3-year rates of MACE due to untreated nonculprit lesions (20.8% vs. 7.7%, p < 0.0001). Among imaged nonculprit lesions, the proportion of PB70 lesions causing MACE was significantly greater than non-PB70 lesions (8.7% vs. 1.0%, p < 0.0001). Conclusions: After successful PCI of all angiographically significant lesions, overall untreated atherosclerotic burden remains high, and PB70 lesions are frequently present in the proximal and mid-coronary tree. Patients with PB70 lesions have greater atherosclerosis throughout the coronary tree, have more thin-cap fibroatheromas, and are at increased risk for future cardiovascular events. (PROSPECT: An Imaging Study in Patients With Unstable Atherosclerotic Lesions; NCT00180466)
KW - acute coronary syndrome
KW - atherosclerosis
KW - intracoronary imaging
UR - https://www.scopus.com/pages/publications/84863337973
U2 - 10.1016/j.jcmg.2012.01.005
DO - 10.1016/j.jcmg.2012.01.005
M3 - Article
C2 - 22421234
AN - SCOPUS:84863337973
SN - 1936-878X
VL - 5
SP - S76-S85
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 3 SUPPL.
ER -