Role of Low Endothelial Shear Stress and Plaque Characteristics in the Prediction of Nonculprit Major Adverse Cardiac Events: The PROSPECT Study
This study sought to determine whether low endothelial shear stress (ESS) adds independent prognostication for future major adverse cardiac events (MACE) in coronary lesions in patients with high-risk acute coronary syndrome (ACS) from the United States and Europe. Low ESS is a proinflammatory, proa...
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| Veröffentlicht in: | JACC. Cardiovascular imaging 2018-03, Vol.11 (3), p.462-471 |
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| creator | Stone, Peter H Maehara, Akiko Coskun, Ahmet Umit Maynard, Charles C Zaromytidou, Marina Siasos, Gerasimos Andreou, Ioannis Fotiadis, Dimitris Stefanou, Kostas Papafaklis, Michail Michalis, Lampros Lansky, Alexandra J Mintz, Gary S Serruys, Patrick W Feldman, Charles L Stone, Gregg W |
| description | This study sought to determine whether low endothelial shear stress (ESS) adds independent prognostication for future major adverse cardiac events (MACE) in coronary lesions in patients with high-risk acute coronary syndrome (ACS) from the United States and Europe.
Low ESS is a proinflammatory, proatherogenic stimulus associated with coronary plaque development, progression, and destabilization in human-like animal models and in humans. Previous natural history studies including baseline ESS characterization investigated low-risk patients.
In the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study, 697 patients with ACS underwent 3-vessel intracoronary imaging. Independent predictors of MACE attributable to untreated nonculprit (nc) coronary lesions during 3.4-year follow-up were large plaque burden (PB), small minimum lumen area (MLA), and thin-cap fibroatheroma (TCFA) morphology. In this analysis, baseline ESS of nc lesions leading to new MACE (nc-MACE lesions) and randomly selected control nc lesions without MACE (nc-non-MACE lesions) were calculated. A propensity score for ESS was constructed for each lesion, and the relationship between ESS and subsequent nc-MACE was examined.
A total of 145 lesions were analyzed in 97 patients: 23 nc-MACE lesions (13 TCFAs, 10 thick-cap fibroatheromas [ThCFAs]), and 122 nc-non-MACE lesions (63 TCFAs, 59 ThCFAs). Low local ESS ( |
| doi_str_mv | 10.1016/j.jcmg.2017.01.031 |
| format | Article |
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Low ESS is a proinflammatory, proatherogenic stimulus associated with coronary plaque development, progression, and destabilization in human-like animal models and in humans. Previous natural history studies including baseline ESS characterization investigated low-risk patients.
In the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study, 697 patients with ACS underwent 3-vessel intracoronary imaging. Independent predictors of MACE attributable to untreated nonculprit (nc) coronary lesions during 3.4-year follow-up were large plaque burden (PB), small minimum lumen area (MLA), and thin-cap fibroatheroma (TCFA) morphology. In this analysis, baseline ESS of nc lesions leading to new MACE (nc-MACE lesions) and randomly selected control nc lesions without MACE (nc-non-MACE lesions) were calculated. A propensity score for ESS was constructed for each lesion, and the relationship between ESS and subsequent nc-MACE was examined.
A total of 145 lesions were analyzed in 97 patients: 23 nc-MACE lesions (13 TCFAs, 10 thick-cap fibroatheromas [ThCFAs]), and 122 nc-non-MACE lesions (63 TCFAs, 59 ThCFAs). Low local ESS (<1.3 Pa) was strongly associated with subsequent nc-MACE compared with physiological/high ESS (≥1.3 Pa) (23 of 101 [22.8%]) versus (0 of 44 [0%]). In propensity-adjusted Cox regression, low ESS was strongly associated with MACE (hazard ratio: 4.34; 95% confidence interval: 1.89 to 10.00; p < 0.001). Categorizing plaques by anatomic risk (high risk: ≥2 high-risk characteristics PB ≥70%, MLA ≤4 mm
, or TCFA), high anatomic risk, and low ESS were prognostically synergistic: 3-year nc-MACE rates were 52.1% versus 14.4% versus 0.0% in high-anatomic risk/low-ESS, low-anatomic risk/low-ESS, and physiological/high-ESS lesions, respectively (p < 0.0001). No lesion without low ESS led to nc-MACE during follow-up, regardless of PB, MLA, or lesion phenotype at baseline.
Local low ESS provides incremental risk stratification of untreated coronary lesions in high-risk patients, beyond measures of PB, MLA, and morphology.</description><identifier>EISSN: 1876-7591</identifier><identifier>DOI: 10.1016/j.jcmg.2017.01.031</identifier><identifier>PMID: 28917684</identifier><language>eng</language><publisher>United States</publisher><ispartof>JACC. Cardiovascular imaging, 2018-03, Vol.11 (3), p.462-471</ispartof><rights>Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c260t-18c90a05ced0f9f53193dd8118e1705a25d0cff8e629f2bfb80614157b5cc733</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28917684$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Stone, Peter H</creatorcontrib><creatorcontrib>Maehara, Akiko</creatorcontrib><creatorcontrib>Coskun, Ahmet Umit</creatorcontrib><creatorcontrib>Maynard, Charles C</creatorcontrib><creatorcontrib>Zaromytidou, Marina</creatorcontrib><creatorcontrib>Siasos, Gerasimos</creatorcontrib><creatorcontrib>Andreou, Ioannis</creatorcontrib><creatorcontrib>Fotiadis, Dimitris</creatorcontrib><creatorcontrib>Stefanou, Kostas</creatorcontrib><creatorcontrib>Papafaklis, Michail</creatorcontrib><creatorcontrib>Michalis, Lampros</creatorcontrib><creatorcontrib>Lansky, Alexandra J</creatorcontrib><creatorcontrib>Mintz, Gary S</creatorcontrib><creatorcontrib>Serruys, Patrick W</creatorcontrib><creatorcontrib>Feldman, Charles L</creatorcontrib><creatorcontrib>Stone, Gregg W</creatorcontrib><title>Role of Low Endothelial Shear Stress and Plaque Characteristics in the Prediction of Nonculprit Major Adverse Cardiac Events: The PROSPECT Study</title><title>JACC. Cardiovascular imaging</title><addtitle>JACC Cardiovasc Imaging</addtitle><description>This study sought to determine whether low endothelial shear stress (ESS) adds independent prognostication for future major adverse cardiac events (MACE) in coronary lesions in patients with high-risk acute coronary syndrome (ACS) from the United States and Europe.
Low ESS is a proinflammatory, proatherogenic stimulus associated with coronary plaque development, progression, and destabilization in human-like animal models and in humans. Previous natural history studies including baseline ESS characterization investigated low-risk patients.
In the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study, 697 patients with ACS underwent 3-vessel intracoronary imaging. Independent predictors of MACE attributable to untreated nonculprit (nc) coronary lesions during 3.4-year follow-up were large plaque burden (PB), small minimum lumen area (MLA), and thin-cap fibroatheroma (TCFA) morphology. In this analysis, baseline ESS of nc lesions leading to new MACE (nc-MACE lesions) and randomly selected control nc lesions without MACE (nc-non-MACE lesions) were calculated. A propensity score for ESS was constructed for each lesion, and the relationship between ESS and subsequent nc-MACE was examined.
A total of 145 lesions were analyzed in 97 patients: 23 nc-MACE lesions (13 TCFAs, 10 thick-cap fibroatheromas [ThCFAs]), and 122 nc-non-MACE lesions (63 TCFAs, 59 ThCFAs). Low local ESS (<1.3 Pa) was strongly associated with subsequent nc-MACE compared with physiological/high ESS (≥1.3 Pa) (23 of 101 [22.8%]) versus (0 of 44 [0%]). In propensity-adjusted Cox regression, low ESS was strongly associated with MACE (hazard ratio: 4.34; 95% confidence interval: 1.89 to 10.00; p < 0.001). Categorizing plaques by anatomic risk (high risk: ≥2 high-risk characteristics PB ≥70%, MLA ≤4 mm
, or TCFA), high anatomic risk, and low ESS were prognostically synergistic: 3-year nc-MACE rates were 52.1% versus 14.4% versus 0.0% in high-anatomic risk/low-ESS, low-anatomic risk/low-ESS, and physiological/high-ESS lesions, respectively (p < 0.0001). No lesion without low ESS led to nc-MACE during follow-up, regardless of PB, MLA, or lesion phenotype at baseline.
Local low ESS provides incremental risk stratification of untreated coronary lesions in high-risk patients, beyond measures of PB, MLA, and morphology.</description><issn>1876-7591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNo1kEtPAjEcxBsTI4h-AQ-mRy-s_e-rW2-E4CNBIbD3TbcPKVm22HYxfAs_skvE01zmN5MZhO6AREAgf9xGW7H7jGICNCIQkQQu0BAKmo9pxmCArr3fEpKTPKVXaBAXDGhepEP0s7KNwlbjuf3Gs1basFGN4Q1ebxR3eB2c8h7zVuJlw786hacb7rgIyhkfjPDYtLhH8NIpaUQwtj2FfdhWdM3emYDf-dY6PJEH5XxPcycNF3h2UG3wT7g8oavFejmbln1ZJ4836FLzxqvbs45Q-Twrp6_j-eLlbTqZj0WckzCGQjDCSSaUJJrpLAGWSFkAFAooyXicSSK0LlQeMx3Xui5IDilktM6EoEkyQg9_sXtn-1k-VDvjhWoa3irb-QpYSoCxOKG99f5s7eqdklU_a8fdsfo_MfkFaIBzpw</recordid><startdate>201803</startdate><enddate>201803</enddate><creator>Stone, Peter H</creator><creator>Maehara, Akiko</creator><creator>Coskun, Ahmet Umit</creator><creator>Maynard, Charles C</creator><creator>Zaromytidou, Marina</creator><creator>Siasos, Gerasimos</creator><creator>Andreou, Ioannis</creator><creator>Fotiadis, Dimitris</creator><creator>Stefanou, Kostas</creator><creator>Papafaklis, Michail</creator><creator>Michalis, Lampros</creator><creator>Lansky, Alexandra J</creator><creator>Mintz, Gary S</creator><creator>Serruys, Patrick W</creator><creator>Feldman, Charles L</creator><creator>Stone, Gregg W</creator><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>201803</creationdate><title>Role of Low Endothelial Shear Stress and Plaque Characteristics in the Prediction of Nonculprit Major Adverse Cardiac Events: The PROSPECT Study</title><author>Stone, Peter H ; Maehara, Akiko ; Coskun, Ahmet Umit ; Maynard, Charles C ; Zaromytidou, Marina ; Siasos, Gerasimos ; Andreou, Ioannis ; Fotiadis, Dimitris ; Stefanou, Kostas ; Papafaklis, Michail ; Michalis, Lampros ; Lansky, Alexandra J ; Mintz, Gary S ; Serruys, Patrick W ; Feldman, Charles L ; Stone, Gregg W</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c260t-18c90a05ced0f9f53193dd8118e1705a25d0cff8e629f2bfb80614157b5cc733</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Stone, Peter H</creatorcontrib><creatorcontrib>Maehara, Akiko</creatorcontrib><creatorcontrib>Coskun, Ahmet Umit</creatorcontrib><creatorcontrib>Maynard, Charles C</creatorcontrib><creatorcontrib>Zaromytidou, Marina</creatorcontrib><creatorcontrib>Siasos, Gerasimos</creatorcontrib><creatorcontrib>Andreou, Ioannis</creatorcontrib><creatorcontrib>Fotiadis, Dimitris</creatorcontrib><creatorcontrib>Stefanou, Kostas</creatorcontrib><creatorcontrib>Papafaklis, Michail</creatorcontrib><creatorcontrib>Michalis, Lampros</creatorcontrib><creatorcontrib>Lansky, Alexandra J</creatorcontrib><creatorcontrib>Mintz, Gary S</creatorcontrib><creatorcontrib>Serruys, Patrick W</creatorcontrib><creatorcontrib>Feldman, Charles L</creatorcontrib><creatorcontrib>Stone, Gregg W</creatorcontrib><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>JACC. Cardiovascular imaging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stone, Peter H</au><au>Maehara, Akiko</au><au>Coskun, Ahmet Umit</au><au>Maynard, Charles C</au><au>Zaromytidou, Marina</au><au>Siasos, Gerasimos</au><au>Andreou, Ioannis</au><au>Fotiadis, Dimitris</au><au>Stefanou, Kostas</au><au>Papafaklis, Michail</au><au>Michalis, Lampros</au><au>Lansky, Alexandra J</au><au>Mintz, Gary S</au><au>Serruys, Patrick W</au><au>Feldman, Charles L</au><au>Stone, Gregg W</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Role of Low Endothelial Shear Stress and Plaque Characteristics in the Prediction of Nonculprit Major Adverse Cardiac Events: The PROSPECT Study</atitle><jtitle>JACC. Cardiovascular imaging</jtitle><addtitle>JACC Cardiovasc Imaging</addtitle><date>2018-03</date><risdate>2018</risdate><volume>11</volume><issue>3</issue><spage>462</spage><epage>471</epage><pages>462-471</pages><eissn>1876-7591</eissn><abstract>This study sought to determine whether low endothelial shear stress (ESS) adds independent prognostication for future major adverse cardiac events (MACE) in coronary lesions in patients with high-risk acute coronary syndrome (ACS) from the United States and Europe.
Low ESS is a proinflammatory, proatherogenic stimulus associated with coronary plaque development, progression, and destabilization in human-like animal models and in humans. Previous natural history studies including baseline ESS characterization investigated low-risk patients.
In the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study, 697 patients with ACS underwent 3-vessel intracoronary imaging. Independent predictors of MACE attributable to untreated nonculprit (nc) coronary lesions during 3.4-year follow-up were large plaque burden (PB), small minimum lumen area (MLA), and thin-cap fibroatheroma (TCFA) morphology. In this analysis, baseline ESS of nc lesions leading to new MACE (nc-MACE lesions) and randomly selected control nc lesions without MACE (nc-non-MACE lesions) were calculated. A propensity score for ESS was constructed for each lesion, and the relationship between ESS and subsequent nc-MACE was examined.
A total of 145 lesions were analyzed in 97 patients: 23 nc-MACE lesions (13 TCFAs, 10 thick-cap fibroatheromas [ThCFAs]), and 122 nc-non-MACE lesions (63 TCFAs, 59 ThCFAs). Low local ESS (<1.3 Pa) was strongly associated with subsequent nc-MACE compared with physiological/high ESS (≥1.3 Pa) (23 of 101 [22.8%]) versus (0 of 44 [0%]). In propensity-adjusted Cox regression, low ESS was strongly associated with MACE (hazard ratio: 4.34; 95% confidence interval: 1.89 to 10.00; p < 0.001). Categorizing plaques by anatomic risk (high risk: ≥2 high-risk characteristics PB ≥70%, MLA ≤4 mm
, or TCFA), high anatomic risk, and low ESS were prognostically synergistic: 3-year nc-MACE rates were 52.1% versus 14.4% versus 0.0% in high-anatomic risk/low-ESS, low-anatomic risk/low-ESS, and physiological/high-ESS lesions, respectively (p < 0.0001). No lesion without low ESS led to nc-MACE during follow-up, regardless of PB, MLA, or lesion phenotype at baseline.
Local low ESS provides incremental risk stratification of untreated coronary lesions in high-risk patients, beyond measures of PB, MLA, and morphology.</abstract><cop>United States</cop><pmid>28917684</pmid><doi>10.1016/j.jcmg.2017.01.031</doi><tpages>10</tpages></addata></record> |
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| title | Role of Low Endothelial Shear Stress and Plaque Characteristics in the Prediction of Nonculprit Major Adverse Cardiac Events: The PROSPECT Study |
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