Residual Plaque Burden in Patients With Acute Coronary Syndromes After Successful Percutaneous Coronary Intervention
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 f...
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| creator | McPherson, John A., MD Maehara, Akiko, MD Weisz, Giora, MD Mintz, Gary S., MD Cristea, Ecaterina, MD Mehran, Roxana, MD Foster, Michael, MD Verheye, Stefan, MD Rabbani, Leroy, MD Xu, Ke, PhD Fahy, Martin, MSc Templin, Barry, MBA Zhang, Zhen, PhD Lansky, Alexandra J., MD de Bruyne, Bernard, MD Serruys, Patrick W., MD, PhD Stone, Gregg W., MD |
| description | 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 ) |
| doi_str_mv | 10.1016/j.jcmg.2012.01.005 |
| format | Article |
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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 )</description><identifier>ISSN: 1936-878X</identifier><identifier>EISSN: 1876-7591</identifier><identifier>DOI: 10.1016/j.jcmg.2012.01.005</identifier><identifier>PMID: 22421234</identifier><language>eng</language><publisher>United States</publisher><subject>Aged ; Angioplasty, Balloon, Coronary - adverse effects ; Angioplasty, Balloon, Coronary - mortality ; Cardiovascular ; Chi-Square Distribution ; Coronary Angiography ; Coronary Artery Disease - diagnosis ; Coronary Artery Disease - mortality ; Coronary Artery Disease - therapy ; Coronary Stenosis - diagnosis ; Coronary Stenosis - mortality ; Coronary Stenosis - therapy ; Europe - epidemiology ; Female ; Humans ; Kaplan-Meier Estimate ; Logistic Models ; Male ; Middle Aged ; Necrosis ; Plaque, Atherosclerotic - diagnosis ; Plaque, Atherosclerotic - mortality ; Plaque, Atherosclerotic - therapy ; Predictive Value of Tests ; Proportional Hazards Models ; Prospective Studies ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; Time Factors ; Treatment Outcome ; Ultrasonography, Interventional ; United States - epidemiology ; Vascular Calcification - diagnosis ; Vascular Calcification - therapy</subject><ispartof>JACC. Cardiovascular imaging, 2012-03, Vol.5 (3), p.S76-S85</ispartof><rights>American College of Cardiology Foundation</rights><rights>Copyright © 2012 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-c401t-e49d491b4574dfe437b2acce3c2dbd56170e0b9cdef131f039b6365f22f519d63</citedby><cites>FETCH-LOGICAL-c401t-e49d491b4574dfe437b2acce3c2dbd56170e0b9cdef131f039b6365f22f519d63</cites></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/22421234$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>McPherson, John A., MD</creatorcontrib><creatorcontrib>Maehara, Akiko, MD</creatorcontrib><creatorcontrib>Weisz, Giora, MD</creatorcontrib><creatorcontrib>Mintz, Gary S., MD</creatorcontrib><creatorcontrib>Cristea, Ecaterina, MD</creatorcontrib><creatorcontrib>Mehran, Roxana, MD</creatorcontrib><creatorcontrib>Foster, Michael, MD</creatorcontrib><creatorcontrib>Verheye, Stefan, MD</creatorcontrib><creatorcontrib>Rabbani, Leroy, MD</creatorcontrib><creatorcontrib>Xu, Ke, PhD</creatorcontrib><creatorcontrib>Fahy, Martin, MSc</creatorcontrib><creatorcontrib>Templin, Barry, MBA</creatorcontrib><creatorcontrib>Zhang, Zhen, PhD</creatorcontrib><creatorcontrib>Lansky, Alexandra J., MD</creatorcontrib><creatorcontrib>de Bruyne, Bernard, MD</creatorcontrib><creatorcontrib>Serruys, Patrick W., MD, PhD</creatorcontrib><creatorcontrib>Stone, Gregg W., MD</creatorcontrib><title>Residual Plaque Burden in Patients With Acute Coronary Syndromes After Successful Percutaneous Coronary Intervention</title><title>JACC. Cardiovascular imaging</title><addtitle>JACC Cardiovasc Imaging</addtitle><description>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 )</description><subject>Aged</subject><subject>Angioplasty, Balloon, Coronary - adverse effects</subject><subject>Angioplasty, Balloon, Coronary - mortality</subject><subject>Cardiovascular</subject><subject>Chi-Square Distribution</subject><subject>Coronary Angiography</subject><subject>Coronary Artery Disease - diagnosis</subject><subject>Coronary Artery Disease - mortality</subject><subject>Coronary Artery Disease - therapy</subject><subject>Coronary Stenosis - diagnosis</subject><subject>Coronary Stenosis - mortality</subject><subject>Coronary Stenosis - therapy</subject><subject>Europe - epidemiology</subject><subject>Female</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Necrosis</subject><subject>Plaque, Atherosclerotic - diagnosis</subject><subject>Plaque, Atherosclerotic - mortality</subject><subject>Plaque, Atherosclerotic - therapy</subject><subject>Predictive Value of Tests</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Severity of Illness Index</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Ultrasonography, Interventional</subject><subject>United States - epidemiology</subject><subject>Vascular Calcification - diagnosis</subject><subject>Vascular Calcification - therapy</subject><issn>1936-878X</issn><issn>1876-7591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkU9v1DAQxSMEon_gC3BAvnFKmHESJ74gLSuglSpRsSC4WYk9BofEae2k0n57HG2Bk-fwe8_z3mTZK4QCAcXboRj09LPggLwALADqJ9k5to3Im1ri0zTLUuRt0_44yy5iHAAEiKp5np1xXnHkZXWeLV8oOrN2I7sdu_uV2Ps1GPLMeXbbLY78Etl3t_xiO70uxPZzmH0Xjuxw9CbME0W2swsFdli1phjtmowoJLbzNK_xv-DaJ-wh-bnZv8ie2W6M9PLxvcy-ffzwdX-V33z-dL3f3eS6AlxyqqSpJPZV3VTGUlU2Pe_SN6Xmpje1wAYIeqkNWSzRQil7UYracm5rlEaUl9mbk-9dmFO2uKjJRU3jeFpOSS5rwBbbRPITqcMcYyCr7oKb0t4KQW1lq0FtZautbAWoUtlJ9PrRfu0nMv8kf9tNwLsTQCnkg6Og9Oi80934m44Uh3kNPuVXqGIyVYftXtu5kEPyB17-AQ81kzw</recordid><startdate>20120301</startdate><enddate>20120301</enddate><creator>McPherson, John A., MD</creator><creator>Maehara, Akiko, MD</creator><creator>Weisz, Giora, MD</creator><creator>Mintz, Gary S., MD</creator><creator>Cristea, Ecaterina, MD</creator><creator>Mehran, Roxana, MD</creator><creator>Foster, Michael, MD</creator><creator>Verheye, Stefan, MD</creator><creator>Rabbani, Leroy, MD</creator><creator>Xu, Ke, PhD</creator><creator>Fahy, Martin, MSc</creator><creator>Templin, Barry, MBA</creator><creator>Zhang, Zhen, PhD</creator><creator>Lansky, Alexandra J., MD</creator><creator>de Bruyne, Bernard, MD</creator><creator>Serruys, Patrick W., MD, PhD</creator><creator>Stone, Gregg W., MD</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20120301</creationdate><title>Residual Plaque Burden in Patients With Acute Coronary Syndromes After Successful Percutaneous Coronary Intervention</title><author>McPherson, John A., MD ; Maehara, Akiko, MD ; Weisz, Giora, MD ; Mintz, Gary S., MD ; Cristea, Ecaterina, MD ; Mehran, Roxana, MD ; Foster, Michael, MD ; Verheye, Stefan, MD ; Rabbani, Leroy, MD ; Xu, Ke, PhD ; Fahy, Martin, MSc ; Templin, Barry, MBA ; Zhang, Zhen, PhD ; Lansky, Alexandra J., MD ; de Bruyne, Bernard, MD ; Serruys, Patrick W., MD, PhD ; Stone, Gregg W., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c401t-e49d491b4574dfe437b2acce3c2dbd56170e0b9cdef131f039b6365f22f519d63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Aged</topic><topic>Angioplasty, Balloon, Coronary - adverse effects</topic><topic>Angioplasty, Balloon, Coronary - mortality</topic><topic>Cardiovascular</topic><topic>Chi-Square Distribution</topic><topic>Coronary Angiography</topic><topic>Coronary Artery Disease - diagnosis</topic><topic>Coronary Artery Disease - mortality</topic><topic>Coronary Artery Disease - therapy</topic><topic>Coronary Stenosis - diagnosis</topic><topic>Coronary Stenosis - mortality</topic><topic>Coronary Stenosis - therapy</topic><topic>Europe - epidemiology</topic><topic>Female</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Necrosis</topic><topic>Plaque, Atherosclerotic - diagnosis</topic><topic>Plaque, Atherosclerotic - mortality</topic><topic>Plaque, Atherosclerotic - therapy</topic><topic>Predictive Value of Tests</topic><topic>Proportional Hazards Models</topic><topic>Prospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Severity of Illness Index</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Ultrasonography, Interventional</topic><topic>United States - epidemiology</topic><topic>Vascular Calcification - diagnosis</topic><topic>Vascular Calcification - therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>McPherson, John A., MD</creatorcontrib><creatorcontrib>Maehara, Akiko, MD</creatorcontrib><creatorcontrib>Weisz, Giora, MD</creatorcontrib><creatorcontrib>Mintz, Gary S., MD</creatorcontrib><creatorcontrib>Cristea, Ecaterina, MD</creatorcontrib><creatorcontrib>Mehran, Roxana, MD</creatorcontrib><creatorcontrib>Foster, Michael, MD</creatorcontrib><creatorcontrib>Verheye, Stefan, MD</creatorcontrib><creatorcontrib>Rabbani, Leroy, MD</creatorcontrib><creatorcontrib>Xu, Ke, PhD</creatorcontrib><creatorcontrib>Fahy, Martin, MSc</creatorcontrib><creatorcontrib>Templin, Barry, MBA</creatorcontrib><creatorcontrib>Zhang, Zhen, PhD</creatorcontrib><creatorcontrib>Lansky, Alexandra J., MD</creatorcontrib><creatorcontrib>de Bruyne, Bernard, MD</creatorcontrib><creatorcontrib>Serruys, Patrick W., MD, PhD</creatorcontrib><creatorcontrib>Stone, Gregg W., MD</creatorcontrib><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 imaging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>McPherson, John A., MD</au><au>Maehara, Akiko, MD</au><au>Weisz, Giora, MD</au><au>Mintz, Gary S., MD</au><au>Cristea, Ecaterina, MD</au><au>Mehran, Roxana, MD</au><au>Foster, Michael, MD</au><au>Verheye, Stefan, MD</au><au>Rabbani, Leroy, MD</au><au>Xu, Ke, PhD</au><au>Fahy, Martin, MSc</au><au>Templin, Barry, MBA</au><au>Zhang, Zhen, PhD</au><au>Lansky, Alexandra J., MD</au><au>de Bruyne, Bernard, MD</au><au>Serruys, Patrick W., MD, PhD</au><au>Stone, Gregg W., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Residual Plaque Burden in Patients With Acute Coronary Syndromes After Successful Percutaneous Coronary Intervention</atitle><jtitle>JACC. Cardiovascular imaging</jtitle><addtitle>JACC Cardiovasc Imaging</addtitle><date>2012-03-01</date><risdate>2012</risdate><volume>5</volume><issue>3</issue><spage>S76</spage><epage>S85</epage><pages>S76-S85</pages><issn>1936-878X</issn><eissn>1876-7591</eissn><abstract>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 )</abstract><cop>United States</cop><pmid>22421234</pmid><doi>10.1016/j.jcmg.2012.01.005</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Angioplasty, Balloon, Coronary - adverse effects Angioplasty, Balloon, Coronary - mortality Cardiovascular Chi-Square Distribution Coronary Angiography Coronary Artery Disease - diagnosis Coronary Artery Disease - mortality Coronary Artery Disease - therapy Coronary Stenosis - diagnosis Coronary Stenosis - mortality Coronary Stenosis - therapy Europe - epidemiology Female Humans Kaplan-Meier Estimate Logistic Models Male Middle Aged Necrosis Plaque, Atherosclerotic - diagnosis Plaque, Atherosclerotic - mortality Plaque, Atherosclerotic - therapy Predictive Value of Tests Proportional Hazards Models Prospective Studies Risk Assessment Risk Factors Severity of Illness Index Time Factors Treatment Outcome Ultrasonography, Interventional United States - epidemiology Vascular Calcification - diagnosis Vascular Calcification - therapy |
| title | Residual Plaque Burden in Patients With Acute Coronary Syndromes After Successful Percutaneous Coronary Intervention |
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