Clinical and angiographic characteristics of patients likely to have vulnerable plaques: Analysis from the PROSPECT study

Christos V. Bourantas, Hector M. Garcia-Garcia, Vasim Farooq, Akiko Maehara, Ke Xu, Philippe Généreux, Roberto Diletti, Takashi Muramatsu, Martin Fahy, Giora Weisz, Gregg W. Stone, Patrick W. Serruys

研究成果: ジャーナルへの寄稿学術論文査読

68 被引用数 (Scopus)

抄録

Objectives This study sought to determine the clinical and angiographic variables that would identify patients with high-risk "vulnerable" coronary plaques. Background In the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study, in patients successfully treated for acute coronary syndrome (ACS), plaque composition, plaque burden, and minimal luminal area as detected by 3-vessel radiofrequency intravascular ultrasound (IVUS) imaging were associated with an increased risk of developing future events from untreated atherosclerotic lesions (vulnerable plaques). Whether baseline demographic and angiographic findings can be used to identify patients most likely to have vulnerable coronary plaques has not been examined. Methods On the basis of 3-vessel radiofrequency IVUS imaging, patents in the PROSPECT trial were classified in 2 groups according to whether or not one or more untreated high-risk plaques were present, defined as having ≥2 high-risk features (a thin-cap fibroatheroma, plaque burden ≥70%, and/or minimal luminal area ≤4 mm2). Results The high-risk group (those with one or more high-risk lesions) had higher Framingham risk score (7.5 ± 3.4 vs. 6.9 ± 3.3; p = 0.04), more extensive coronary artery disease, and more nonculprit lesion-related cardiovascular events during the 3-year follow-up (hazard ratio: 2.63; 95% confidence interval: 1.62 to 3.66; p < 0.0001). However, demographic factors had poor discrimination in detecting high-risk patients (area under the curve 0.55), and discrimination was only slightly improved when angiographic variables were entered into the model (area under the curve 0.64). Conclusions Clinical and angiographic characteristics had poor predictive accuracy in identifying patients with untreated high-risk plaques related to future adverse events. This finding highlights the potential value of comprehensive 3-vessel imaging assessment (either invasive or noninvasive) to evaluate plaque phenotype for more accurate risk stratification of patients admitted with ACS.

本文言語英語
ページ(範囲)1263-1272
ページ数10
ジャーナルJACC: Cardiovascular Imaging
6
12
DOI
出版ステータス出版済み - 12-2013
外部発表はい

All Science Journal Classification (ASJC) codes

  • 放射線学、核医学およびイメージング
  • 循環器および心血管医学

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