Author + information
- Received September 21, 2010
- Revision received December 16, 2010
- Accepted February 14, 2011
- Published online March 1, 2012.
- Salvatore Brugaletta, MD⁎,†,
- Hector M. Garcia-Garcia, MD, PhD⁎,‡,
- Patrick W. Serruys, MD, PhD⁎,⁎ (, )
- Akiko Maehara, MD§,
- Vasim Farooq, MBChB⁎,
- Gary S. Mintz, MD§,
- Bernard de Bruyne, MD∥,
- Steven P. Marso, MD¶,
- Stefan Verheye, MD, PhD#,
- Dariusz Dudek, MD⁎⁎,
- Christian W. Hamm, MD††,
- Nahim Farhat, MD‡‡,
- Francois Schiele, MD§§,
- John McPherson, MD∥∥,
- Amir Lerman, MD¶¶,
- Pedro R. Moreno, MD##,
- Bertil Wennerblom, MD⁎⁎⁎,
- Martin Fahy, MSc§,
- Barry Templin, MBA†††,
- Marie-Angel Morel, BSc‡,
- Gerrit Anne van Es, PhD§ and
- Gregg W. Stone, MD§
- ↵⁎Reprint requests and correspondence:
Dr. Patrick W. Serruys, Thoraxcenter, Ba-583, ‘s Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands
Objectives The purpose of this study was to correlate adverse events at long-term follow-up in patients after an acute coronary syndrome with coronary plaque characteristics derived from simultaneous evaluation of their mechanical and compositional properties using virtual histology (intravascular ultrasound virtual histology) and palpography.
Background Fibroatheroma is the plaque morphology with the highest risk of causing adverse cardiac events. Palpography can potentially assess the local mechanical plaque properties with the possibility of identifying fibroatheroma with the highest risk of rupture.
Methods A total of 114 patients with acute coronary syndrome from the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) trial underwent a single ultrasound imaging investigation of their 3 coronary vessels with the co-registration of intravascular ultrasound virtual histology and palpography. Major adverse cardiac events (MACE) (cardiac death, cardiac arrest, myocardial infarction, or unstable or progressive angina) were collected up to a median follow-up of 3.4 years and adjudicated to originally treated culprit versus untreated nonculprit lesions.
Results In total, 488 necrotic core–rich plaques were identified and subclassified as thin-cap fibroatheroma (n = 111), calcified thick-cap fibroatheroma (n = 213), and noncalcified thick-cap fibroatheroma (n = 164) and matched to their co-registered palpography data. A total of 16 MACE, adjudicated to untreated nonculprit lesions, were recorded at follow-up. In patients in whom MACE developed, fibroatheroma were larger (plaque area 10.0 mm2 [range: 8.4 to 11.6 mm2] vs. 8.2 mm2 [range: 7.7 to 8.8 mm2] (p = 0.03) compared with patients who were MACE free. By palpography, the maximum and the density strain values did not differ between the varying subtypes of fibroatheroma of patients with or without MACE during follow-up.
Conclusions In acute coronary syndromes, patients treated with stents and contemporary pharmacotherapy, palpography did not provide additional diagnostic information for the identification of fibroatheroma with a high risk of rupture and MACE during long-term follow-up. (Providing Regional Observations to Study Predictors of Events in the Coronary Tree [PROSPECT]: An Imaging Study in Patients With Unstable Atherosclerotic Lesions; NCT00180466)
The study was sponsored and funded by Abbott Vascular and Volcano Corporation. Dr. Maehara has received a research grant from Boston Scientific and lecture fees from Volcano. Dr. Mintz has received grant support, consulting fees, and honoraria from Volcano and Boston Scientific. Dr. Dudek has received research grants from or served as consultant/advisory board member for Abbott, Adamed, Biotronik, Balton, Bayer, BBraun, BioMatrix, Boston Scientific, Boehringer Ingelheim, Bristol-Myers Squibb, Cordis, Cook, Eli Lilly, EuroCor, Glaxo, Invatec, Medtronic, The Medicines Company, MSD, Nycomed, Orbus-Neich, Pfizer, Possis, Promed, Sanofi-Aventis, Siemens, Solvay, Terumo, and Tyco. Dr. McPherson is a consultant for Abbott Vascular. Dr. Stone has received research grants from Volcano and InfraReDx; and is on the scientific advisory board and receives honoraria from Boston Scientific and Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 21, 2010.
- Revision received December 16, 2010.
- Accepted February 14, 2011.
- American College of Cardiology Foundation