A Prospective Natural-History Study of Coronary Atherosclerosis

In a prospective study, 697 patients with acute coronary syndromes underwent three-vessel coronary angiography and imaging after PCI. Of 132 subsequent major adverse cardiovascular events, approximately half occurred at the site of the previous culprit lesion. Approximately 1,350,000 Americans annually have an acute coronary syndrome (unstable angina or myocardial infarction with or without ST-segment elevation). 1 Although percutaneous coronary intervention and pharmacologic therapies have improved the prognosis for such patients, 1 – 4 recurrent major adverse cardiovascular events occur in a substantial proportion of cases. Recurrent cardiac ischemic events can be due to recurrence at the original treatment site, the presence of untreated lesions elsewhere, or progressive lesions. However, prospective, systematic data on the origin of recurrent events are lacking. Moreover, retrospective studies have shown that most atherosclerotic plaques responsible for future acute coronary syndromes are angiographically mild, 5 , . . .