Residual plaque burden in patients with acute coronary syndromes after successful percutaneous coronary intervention
John A McPherson, Akiko Maehara, Giora Weisz, Gary S Mintz, Ecaterina Cristea, Roxana Mehran, Michael Foster, Stefan Verheye, Leroy Rabbani, Ke Xu, Martin Fahy, Barry Templin, Zhen Zhang, Alexandra J Lansky, Bernard de Bruyne, Patrick W Serruys, Gregg W Stone, John A McPherson, Akiko Maehara, Giora Weisz, Gary S Mintz, Ecaterina Cristea, Roxana Mehran, Michael Foster, Stefan Verheye, Leroy Rabbani, Ke Xu, Martin Fahy, Barry Templin, Zhen Zhang, Alexandra J Lansky, Bernard de Bruyne, Patrick W Serruys, Gregg W Stone
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).
Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed