Clinical Outcome of Nonculprit Plaque Ruptures in Patients With Acute Coronary Syndrome in the PROSPECT Study

• Published in: JACC. Cardiovascular imaging Vol. 7; no. 4; pp. 397 - 405
• Main Authors: Xie, Yong, Mintz, Gary S., Yang, Junqing, Doi, Hiroshi, Iñiguez, Andrés, Dangas, George D., Serruys, Patrick W., McPherson, John A., Wennerblom, Bertil, Xu, Ke, Weisz, Giora, Stone, Gregg W., Maehara, Akiko
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2014
• Subjects: Acute Coronary Syndrome - diagnosis; Acute Coronary Syndrome - etiology; Acute Coronary Syndrome - therapy; acute coronary syndromes; Aged; Cardiovascular; Chi-Square Distribution; Coronary Angiography; Coronary Artery Disease - complications; Coronary Artery Disease - diagnosis; Coronary Artery Disease - therapy; Coronary Thrombosis - diagnosis; Coronary Thrombosis - etiology; Coronary Thrombosis - therapy; Coronary Vessels - diagnostic imaging; Coronary Vessels - pathology; Female; Humans; intravascular ultrasound; Least-Squares Analysis; Logistic Models; Male; Middle Aged; Multimodal Imaging - methods; Multivariate Analysis; Necrosis; Odds Ratio; Percutaneous Coronary Intervention - instrumentation; plaque rupture; Plaque, Atherosclerotic; Predictive Value of Tests; Prospective Studies; Risk Factors; Rupture, Spontaneous; Stents; Time Factors; Treatment Outcome; Ultrasonography, Interventional; CSA; ACS; intravascular ultrasound; VH; MLA; MACE; CI; plaque rupture; IVUS; ThCFA; TCFA; acute coronary syndromes; cross-sectional area; virtual histology; major adverse cardiac event(s); minimum lumen area; acute coronary syndrome; thick-cap fibroatheroma; confidence interval; thin-cap fibroatheroma
• ISSN: 1936-878X; 1876-7591; 1876-7591
• DOI: 10.1016/j.jcmg.2013.10.010

The aim of this study was to report the frequency, patient and lesion-related characteristics, and outcomes of subclinical, nonculprit plaque ruptures in the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study. Plaque rupture and subsequent thrombosis is the most common cause of acute coronary syndrome (ACS). Secondary, subclinical, nonculprit plaque ruptures have been seen in both stable patients and patients with ACS; however, reports of the natural history of these secondary plaque ruptures are limited. After successful stenting in 697 patients with ACS, 3-vessel grayscale and intravascular ultrasound virtual histology (IVUS-VH) was performed in the proximal-mid segments of all 3 coronary arteries as part of a prospective multicenter study. Among 660 patients with complete IVUS data, 128 plaque ruptures were identified in 105 nonculprit lesions in 100 arteries from 93 patients (14.1%). Although the minimum lumen area (MLA) was similar, the plaque burden was significantly greater in nonculprit lesions with a plaque rupture compared with nonculprit lesions without a plaque rupture (66.0% [95% confidence interval: 64.5% to 67.4%] vs. 56.0% [95% confidence interval: 55.6% to 56.4%]; p < 0.0001). IVUS-VH analysis revealed that a nonculprit lesion with a plaque rupture was more often classified as a fibroatheroma than a nonculprit lesion without a plaque rupture (77.1% vs. 51.4%; p < 0.0001). Independent predictors of a plaque rupture were lesion length (per 10 mm; odds ratio: 1.30; p < 0.0001), plaque burden at the MLA site (per 10%; odds ratio: 2.56; p < 0.0001), vessel area at the MLA site (per 1 mm2; odds ratio: 1.13; p < 0.0001), and VH–thin-cap fibroatheroma (odds ratio: 1.80; p = 0.016). During 3 years of follow-up, the incidence of overall major adverse cardiac events did not differ significantly between the patients with and patients without subclinical, nonculprit plaque ruptures. Secondary, nonculprit plaque ruptures were seen in 14% of patients with ACS and were associated with a fibroatheroma phenotype with a residual necrotic core but not with adverse outcomes if patients were treated with optimal medical therapy as part of a multicenter study. (Providing Regional Observations to Study Predictors of Events in the Coronary Tree [PROSPECT]; NCT00180466)