This study investigated coronary artery remodeling patterns associated with clinical outcomes.
Background
In the prospective, multicenter PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree: An Imaging Study in Patients With Unstable Atherosclerotic Lesions) study, reported predictors of nonculprit lesion (NCL) major adverse cardiac events (MACE) were an intravascular ultrasound (IVUS) minimal lumen area (MLA) ≤4 mm2, a plaque burden ≥70%, and a IVUS–virtual histology (VH) thin-cap fibroatheroma (TCFA), but not lesion site remodeling.
Methods
Overall, 697 consecutive patients with an acute coronary syndrome were enrolled and underwent 3-vessel gray-scale and IVUS-VH; 3,223 NCLs were identified by IVUS. The remodeling index (RI) was calculated as the external elastic membrane area at the MLA site divided by the average of the proximal and distal reference external elastic membrane areas. First, one third of the patients were randomly selected to determine RI cutoffs related to NCL MACE (development cohort). Receiver-operating characteristic analysis showed that there were 2 separate cut points that predicted NCL MACE: RI = 0.8789 and RI = 1.0046 (area under the curve = 0.663). These cut points were used to define negative remodeling as an RI <0.88, intermediate remodeling as an RI of 0.88 to 1.00, and positive remodeling as an RI >1.00. Second, we used the remaining two-thirds of patients to validate these cut points with respect to lesion morphology and clinical outcomes (validation cohort).
Results
Kaplan-Meier curve analysis in the validation cohort showed that NCL MACE occurred more frequent (and equally) in negative and positive remodeling lesions compared with intermediate remodeling lesions. In this cohort, negative remodeling lesions had the smallest MLA, positive remodeling lesions had the largest plaque burden, and VH TCFA, especially VH TCFA with multiple necrotic cores, was most common in negatively remodeling lesions.
Conclusions
The present study showed the novel concept that positive and negative lesion site remodeling was associated with unanticipated NCL MACE in the PROSPECT study. (PROSPECT: An Imaging Study in Patients With Unstable Atherosclerotic Lesions [PROSPECT]; NCT00180466)
Key Words
cardiovascular events
intravascular ultrasound
remodeling
Abbreviations and Acronyms
CSA
cross-sectional
DC
dense calcium
EEM
external elastic membrane
FF
fibrofatty
FT
fibrotic
IVUS
intravascular ultrasound
MLA
minimal lumen area
NCL MACE
nonculprit lesion major adverse cardiac event(s)
NC
necrotic core
RI
remodeling index
ROC
receiver-operating characteristic
TCFA
thin-cap fibroatheroma
ThCFA
thick-cap fibroatheroma
VH
virtual histology
Cited by (0)
The PROSPECT study was funded by Abbott Vascular and Volcano Corporation. Dr. Mintz has received grant support from and is a consultant to Volcano Corporation, Boston Scientific, and InfraReDx. Dr. Dudek has received consulting and lecture fees from Abbott, Adamed, Adyton Medical Polska, Abiomed Europe, AstraZeneca, Biotronik, Balton, Bayer, BBraun, BioMatrix, Boston Scientific, Boehringer Ingelheim, Bracco, Bristol-Myers Squibb, Comesa Polska, Cordis, Cook, Covidien Polska Sp. z o.o., DRG MedTek, Eli Lilly, EuroCor, Hammermed, GE Healthcare, GlaxoSmithKline, Inspire-MD, Iroko Cardio International, Medianet Sp. z o.o., Medtronic, Medicines Company, Meril Life Sciences, MSD, Orbus-Neich, Pfizer, Possis, ProCardia Medical, Promed, REVA Medical, Sanofi-Aventis, Siemens, Solvay, Stentys, St. Jude Medical, Terumo, Tyco, and Volcano. Dr. Weisz is a consultant to InfraReDx. Dr. de Bruyne has received grant support from Abbott Vascular, Medtronic, and St. Jude Medical. Dr. Stone is a consultant to Volcano and InfraReDx. Dr. Maehara has received grants from and is a consultant to Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Renu Virmani, MD, served as Guest Editor for this Paper.
