Left Main Coronary Atherosclerosis Progression, Constrictive Remodeling, and Clinical Events
Objectives The aim of this study was to evaluate the progression of atherosclerosis within the left main coronary artery (LMCA) in association with risk factor modifying therapies. Background Despite studies demonstrating slowing of disease progression within epicardial coronaries with risk factor m...
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| creator | Puri, Rishi, MBBS Wolski, Kathy, MPH Uno, Kiyoko, MD, PhD Kataoka, Yu, MD King, Karilane L., MS Crowe, Timothy D., MS Kapadia, Samir R., MD Tuzcu, E. Murat, MD Nissen, Steven E., MD Nicholls, Stephen J., MBBS, PhD |
| description | Objectives The aim of this study was to evaluate the progression of atherosclerosis within the left main coronary artery (LMCA) in association with risk factor modifying therapies. Background Despite studies demonstrating slowing of disease progression within epicardial coronaries with risk factor modification, little is known about the natural history and clinical sequelae of atherosclerosis progression within the LMCA. Methods In 340 patients with angiographic coronary artery disease who underwent serial intravascular ultrasound imaging to evaluate the effects of anti atherosclerotic therapies across 7 clinical trials, LMCA and epicardial disease progression was characterized. Relationships between changes in plaque burden with remodeling parameters and the incidence of major adverse cardiovascular events (MACE) (death, myocardial infarction, hospital stay for unstable angina, and coronary revascularization) were investigated. Results Plaque regression was observed in the LMCA segment, and progression was observed in adjacent epicardial segments (percent atheroma volume [PAV] −0.39 ± 0.1% vs. +0.37 ± 0.1%, p < 0.001). Changes in LMCA lumen volume correlated strongly with changes in external elastic membrane (beta coefficient 0.91, p < 0.001) and negatively with the change in PAV (beta coefficient −0.55, p < 0.001). Patients who experienced a MACE had smaller baseline LMCA minimum lumen area (11.6 vs. 12.2 mm2 , p = 0.05) and greater progression of PAV in the LMCA (+0.51 ± 0.3% vs. −0.35 ± 0.2%, p = 0.02) compared with those who were MACE-free. Significant reductions from baseline in both external elastic membrane (−4.7 ± 1.7 mm3 , p < 0.01) and lumen volumes (−4.0 ± 1 mm3 , p < 0.01) were also observed in those having an event. Conclusions Left main coronary atherosclerosis responds to systemic risk factor modification. Patients experiencing a MACE were more likely to demonstrate progressive disease and constrictive arterial remodeling within the LMCA segment. |
| doi_str_mv | 10.1016/j.jcin.2012.09.006 |
| format | Article |
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Murat, MD ; Nissen, Steven E., MD ; Nicholls, Stephen J., MBBS, PhD</creator><creatorcontrib>Puri, Rishi, MBBS ; Wolski, Kathy, MPH ; Uno, Kiyoko, MD, PhD ; Kataoka, Yu, MD ; King, Karilane L., MS ; Crowe, Timothy D., MS ; Kapadia, Samir R., MD ; Tuzcu, E. Murat, MD ; Nissen, Steven E., MD ; Nicholls, Stephen J., MBBS, PhD</creatorcontrib><description>Objectives The aim of this study was to evaluate the progression of atherosclerosis within the left main coronary artery (LMCA) in association with risk factor modifying therapies. Background Despite studies demonstrating slowing of disease progression within epicardial coronaries with risk factor modification, little is known about the natural history and clinical sequelae of atherosclerosis progression within the LMCA. Methods In 340 patients with angiographic coronary artery disease who underwent serial intravascular ultrasound imaging to evaluate the effects of anti atherosclerotic therapies across 7 clinical trials, LMCA and epicardial disease progression was characterized. Relationships between changes in plaque burden with remodeling parameters and the incidence of major adverse cardiovascular events (MACE) (death, myocardial infarction, hospital stay for unstable angina, and coronary revascularization) were investigated. Results Plaque regression was observed in the LMCA segment, and progression was observed in adjacent epicardial segments (percent atheroma volume [PAV] −0.39 ± 0.1% vs. +0.37 ± 0.1%, p < 0.001). Changes in LMCA lumen volume correlated strongly with changes in external elastic membrane (beta coefficient 0.91, p < 0.001) and negatively with the change in PAV (beta coefficient −0.55, p < 0.001). Patients who experienced a MACE had smaller baseline LMCA minimum lumen area (11.6 vs. 12.2 mm2 , p = 0.05) and greater progression of PAV in the LMCA (+0.51 ± 0.3% vs. −0.35 ± 0.2%, p = 0.02) compared with those who were MACE-free. Significant reductions from baseline in both external elastic membrane (−4.7 ± 1.7 mm3 , p < 0.01) and lumen volumes (−4.0 ± 1 mm3 , p < 0.01) were also observed in those having an event. Conclusions Left main coronary atherosclerosis responds to systemic risk factor modification. Patients experiencing a MACE were more likely to demonstrate progressive disease and constrictive arterial remodeling within the LMCA segment.</description><identifier>ISSN: 1936-8798</identifier><identifier>EISSN: 1876-7605</identifier><identifier>DOI: 10.1016/j.jcin.2012.09.006</identifier><identifier>PMID: 23347860</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Angina, Unstable - etiology ; Angina, Unstable - therapy ; arterial remodeling ; atherosclerosis progression ; Cardiovascular ; Chi-Square Distribution ; Coronary Angiography ; Coronary Artery Disease - complications ; Coronary Artery Disease - mortality ; Coronary Artery Disease - pathology ; Coronary Artery Disease - therapy ; Coronary Vessels - diagnostic imaging ; Coronary Vessels - pathology ; Disease Progression ; Female ; Hospitalization ; Humans ; intravascular ultrasound ; left main disease ; Linear Models ; Male ; Middle Aged ; Myocardial Infarction - etiology ; Myocardial Infarction - therapy ; Myocardial Revascularization ; Plaque, Atherosclerotic ; Predictive Value of Tests ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome ; Ultrasonography, Interventional</subject><ispartof>JACC. Cardiovascular interventions, 2013, Vol.6 (1), p.29-35</ispartof><rights>American College of Cardiology Foundation</rights><rights>2013 American College of Cardiology Foundation</rights><rights>Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c411t-b234f4e6827f51a95aadaad3b78573f3f9fc408e140a8ba44e6a894a79f931433</citedby><cites>FETCH-LOGICAL-c411t-b234f4e6827f51a95aadaad3b78573f3f9fc408e140a8ba44e6a894a79f931433</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1936879812010904$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3536,4009,27902,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23347860$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Puri, Rishi, MBBS</creatorcontrib><creatorcontrib>Wolski, Kathy, MPH</creatorcontrib><creatorcontrib>Uno, Kiyoko, MD, PhD</creatorcontrib><creatorcontrib>Kataoka, Yu, MD</creatorcontrib><creatorcontrib>King, Karilane L., MS</creatorcontrib><creatorcontrib>Crowe, Timothy D., MS</creatorcontrib><creatorcontrib>Kapadia, Samir R., MD</creatorcontrib><creatorcontrib>Tuzcu, E. Murat, MD</creatorcontrib><creatorcontrib>Nissen, Steven E., MD</creatorcontrib><creatorcontrib>Nicholls, Stephen J., MBBS, PhD</creatorcontrib><title>Left Main Coronary Atherosclerosis Progression, Constrictive Remodeling, and Clinical Events</title><title>JACC. Cardiovascular interventions</title><addtitle>JACC Cardiovasc Interv</addtitle><description>Objectives The aim of this study was to evaluate the progression of atherosclerosis within the left main coronary artery (LMCA) in association with risk factor modifying therapies. Background Despite studies demonstrating slowing of disease progression within epicardial coronaries with risk factor modification, little is known about the natural history and clinical sequelae of atherosclerosis progression within the LMCA. Methods In 340 patients with angiographic coronary artery disease who underwent serial intravascular ultrasound imaging to evaluate the effects of anti atherosclerotic therapies across 7 clinical trials, LMCA and epicardial disease progression was characterized. Relationships between changes in plaque burden with remodeling parameters and the incidence of major adverse cardiovascular events (MACE) (death, myocardial infarction, hospital stay for unstable angina, and coronary revascularization) were investigated. Results Plaque regression was observed in the LMCA segment, and progression was observed in adjacent epicardial segments (percent atheroma volume [PAV] −0.39 ± 0.1% vs. +0.37 ± 0.1%, p < 0.001). Changes in LMCA lumen volume correlated strongly with changes in external elastic membrane (beta coefficient 0.91, p < 0.001) and negatively with the change in PAV (beta coefficient −0.55, p < 0.001). Patients who experienced a MACE had smaller baseline LMCA minimum lumen area (11.6 vs. 12.2 mm2 , p = 0.05) and greater progression of PAV in the LMCA (+0.51 ± 0.3% vs. −0.35 ± 0.2%, p = 0.02) compared with those who were MACE-free. Significant reductions from baseline in both external elastic membrane (−4.7 ± 1.7 mm3 , p < 0.01) and lumen volumes (−4.0 ± 1 mm3 , p < 0.01) were also observed in those having an event. Conclusions Left main coronary atherosclerosis responds to systemic risk factor modification. Patients experiencing a MACE were more likely to demonstrate progressive disease and constrictive arterial remodeling within the LMCA segment.</description><subject>Aged</subject><subject>Angina, Unstable - etiology</subject><subject>Angina, Unstable - therapy</subject><subject>arterial remodeling</subject><subject>atherosclerosis progression</subject><subject>Cardiovascular</subject><subject>Chi-Square Distribution</subject><subject>Coronary Angiography</subject><subject>Coronary Artery Disease - complications</subject><subject>Coronary Artery Disease - mortality</subject><subject>Coronary Artery Disease - pathology</subject><subject>Coronary Artery Disease - therapy</subject><subject>Coronary Vessels - diagnostic imaging</subject><subject>Coronary Vessels - pathology</subject><subject>Disease Progression</subject><subject>Female</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>intravascular ultrasound</subject><subject>left main disease</subject><subject>Linear Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - etiology</subject><subject>Myocardial Infarction - therapy</subject><subject>Myocardial Revascularization</subject><subject>Plaque, Atherosclerotic</subject><subject>Predictive Value of Tests</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Ultrasonography, Interventional</subject><issn>1936-8798</issn><issn>1876-7605</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kV1LHDEUhoNU1Fr_gBcyl71wpvmaSQJSkMV-wEpLbe-EkM2c2IyziSazC_57M-y2F70ohORcPO8L5wlC5wQ3BJPuw9AM1oeGYkIbrBqMuwN0QqToatHh9k2ZFetqKZQ8Rm9zHgqAlaBH6JgyxoXs8Am6X4KbqlvjQ7WIKQaTXqrr6TekmO043z5X31N8SJCzj-GyUCFPydvJb6H6AevYw-jDw2VlQl8tyuitGaubLYQpv0OHzowZzvbvKfr16ebn4ku9_Pb56-J6WVtOyFSvKOOOQyepcC0xqjWmL4ethGwFc8wpZzmWQDg2cmV4QY1U3AjlFCOcsVP0ftf7lOLzBvKk1z5bGEcTIG6yJlRSzIlkbUHpDrVlt5zA6afk12VrTbCerepBz1b1bFVjpYu0ErrY929Wa-j_Rv5oLMDVDoCy5dZD0tl6CBZ6n8BOuo_-__0f_4nbvchHeIE8xE0KxZ8mOpeMvpv_df5WUkqwwpy9AuJVnfk</recordid><startdate>2013</startdate><enddate>2013</enddate><creator>Puri, Rishi, MBBS</creator><creator>Wolski, Kathy, MPH</creator><creator>Uno, Kiyoko, MD, PhD</creator><creator>Kataoka, Yu, MD</creator><creator>King, Karilane L., MS</creator><creator>Crowe, Timothy D., MS</creator><creator>Kapadia, Samir R., MD</creator><creator>Tuzcu, E. 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Murat, MD</creatorcontrib><creatorcontrib>Nissen, Steven E., MD</creatorcontrib><creatorcontrib>Nicholls, Stephen J., MBBS, PhD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>JACC. Cardiovascular interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Puri, Rishi, MBBS</au><au>Wolski, Kathy, MPH</au><au>Uno, Kiyoko, MD, PhD</au><au>Kataoka, Yu, MD</au><au>King, Karilane L., MS</au><au>Crowe, Timothy D., MS</au><au>Kapadia, Samir R., MD</au><au>Tuzcu, E. Murat, MD</au><au>Nissen, Steven E., MD</au><au>Nicholls, Stephen J., MBBS, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Left Main Coronary Atherosclerosis Progression, Constrictive Remodeling, and Clinical Events</atitle><jtitle>JACC. Cardiovascular interventions</jtitle><addtitle>JACC Cardiovasc Interv</addtitle><date>2013</date><risdate>2013</risdate><volume>6</volume><issue>1</issue><spage>29</spage><epage>35</epage><pages>29-35</pages><issn>1936-8798</issn><eissn>1876-7605</eissn><abstract>Objectives The aim of this study was to evaluate the progression of atherosclerosis within the left main coronary artery (LMCA) in association with risk factor modifying therapies. Background Despite studies demonstrating slowing of disease progression within epicardial coronaries with risk factor modification, little is known about the natural history and clinical sequelae of atherosclerosis progression within the LMCA. Methods In 340 patients with angiographic coronary artery disease who underwent serial intravascular ultrasound imaging to evaluate the effects of anti atherosclerotic therapies across 7 clinical trials, LMCA and epicardial disease progression was characterized. Relationships between changes in plaque burden with remodeling parameters and the incidence of major adverse cardiovascular events (MACE) (death, myocardial infarction, hospital stay for unstable angina, and coronary revascularization) were investigated. Results Plaque regression was observed in the LMCA segment, and progression was observed in adjacent epicardial segments (percent atheroma volume [PAV] −0.39 ± 0.1% vs. +0.37 ± 0.1%, p < 0.001). Changes in LMCA lumen volume correlated strongly with changes in external elastic membrane (beta coefficient 0.91, p < 0.001) and negatively with the change in PAV (beta coefficient −0.55, p < 0.001). Patients who experienced a MACE had smaller baseline LMCA minimum lumen area (11.6 vs. 12.2 mm2 , p = 0.05) and greater progression of PAV in the LMCA (+0.51 ± 0.3% vs. −0.35 ± 0.2%, p = 0.02) compared with those who were MACE-free. Significant reductions from baseline in both external elastic membrane (−4.7 ± 1.7 mm3 , p < 0.01) and lumen volumes (−4.0 ± 1 mm3 , p < 0.01) were also observed in those having an event. Conclusions Left main coronary atherosclerosis responds to systemic risk factor modification. Patients experiencing a MACE were more likely to demonstrate progressive disease and constrictive arterial remodeling within the LMCA segment.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>23347860</pmid><doi>10.1016/j.jcin.2012.09.006</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Angina, Unstable - etiology Angina, Unstable - therapy arterial remodeling atherosclerosis progression Cardiovascular Chi-Square Distribution Coronary Angiography Coronary Artery Disease - complications Coronary Artery Disease - mortality Coronary Artery Disease - pathology Coronary Artery Disease - therapy Coronary Vessels - diagnostic imaging Coronary Vessels - pathology Disease Progression Female Hospitalization Humans intravascular ultrasound left main disease Linear Models Male Middle Aged Myocardial Infarction - etiology Myocardial Infarction - therapy Myocardial Revascularization Plaque, Atherosclerotic Predictive Value of Tests Risk Assessment Risk Factors Time Factors Treatment Outcome Ultrasonography, Interventional |
| title | Left Main Coronary Atherosclerosis Progression, Constrictive Remodeling, and Clinical Events |
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