Author + information
- Received February 24, 2012
- Revision received August 13, 2012
- Accepted August 21, 2012
- Published online January 1, 2013.
- Zhijing Zhao, MD⁎,
- Bernhard Witzenbichler, MD†,
- Gary S. Mintz, MD‡,
- Markus Jaster, MD†,
- So-Yeon Choi, MD, PhD⁎,
- Xiaofan Wu, MD, PhD⁎,
- Yong He, MD⁎,
- M. Pauliina Margolis, MD, PhD§,
- Ovidiu Dressler, MD⁎,
- Ecaterina Cristea, MD‖,
- Helen Parise, ScD⁎,
- Roxana Mehran, MD¶,
- Gregg W. Stone, MD⁎ and
- Akiko Maehara, MD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Akiko Maehara, Cardiovascular Research Foundation, 111 East 59th Street, New York, New York 10022
Objectives The authors sought to report the temporal stability of an untreated, nonculprit lesion phenotype in patients presenting with ST-segment elevation myocardial infarction (STEMI).
Background The temporal stability of the untreated, nonculprit lesion phenotype has been studied using intravascular ultrasound-virtual histology (IVUS) in patients with stable ischemic heart disease, but not in STEMI patients.
Methods As part of a formal substudy of the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) trial, baseline and 13-month follow-up IVUS was performed in 99 untreated nonculprit lesions in 63 STEMI patients. Lesions were classified as pathological intimal thickening (PIT), IVUS–derived thin-cap fibroatheroma (TCFA), thick-cap fibroatheroma (ThCFA), fibrotic plaque, or fibrocalcific plaque.
Results The frequency of TCFA increased from 41% at baseline to 54% at follow-up, whereas ThCFAs decreased from 41% to 34% and PIT decreased from 16% to 8%. Among the 41 lesions classified at baseline as TCFA, at follow-up, 32 (78%) were still classified as TCFA, whereas 9 (22%) were classified as ThCFAs or fibrotic plaques. An additional 21 lesions at follow-up were newly classified as TCFA, developing from either PIT or ThCFA. TCFA at baseline that evolved into non-TCFAs trended toward a more distal location than TCFA that did not change (p = 0.12). In lesions classified as TCFA, the minimum lumen area (MLA) decreased from 8.1 (interquartile range [IQR]: 7.4 to 8.8) mm2 at baseline to 7.8 (IQR: 7.2 to 8.4) mm2 at follow-up, p < 0.05; this was associated with an increase in percent necrotic core at the MLA site (14% [IQR: 12 to 16] to 19% [IQR: 17 to 22], p < 0.0001) and over the entire length of the lesion (14% [IQR: 12 to 16] to 18% [IQR: 17 to 20], p < 0.0001).
Conclusions Untreated nonculprit lesions in STEMI patients frequently have TCFA morphology that does not change during 13-month follow-up and is accompanied by a decrease in MLA and an increase in necrotic core. (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction [HORIZONS-AMI]; NCT00433966)
Dr. Zhao has received research grants from Boston Scientific China. Dr. Witzenbichler has received speaker's fees (modest) from Boston Scientific and The Medicines Company. Dr. Mintz has received grant support from Volcano Corporation and Boston Scientific; and consulting fees from Volcano Corporation and Boston Scientific. Drs. Wu and He have received research grants from Boston Scientific China. Dr. Margolis was an employee of Volcano Corporation at the time the manuscript of this paper was submitted and holds stock in the company. Dr. Mehran has received research grants from BMS/Sanofi, The Medicines Company, and Lilly/Daiichi Sankyo; serves on the advisory board for Regado Biosciences; and is a consultant for AstraZeneca, Abbott, Johnson & Johnson, Merk Sharp & Dohme, and Maya Medical. Dr. Stone is a consultant for Volcano Corporation. Dr. Maehara has received speaker's fees from St. Jude Medical; and grant support from Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 24, 2012.
- Revision received August 13, 2012.
- Accepted August 21, 2012.
- American College of Cardiology Foundation