Author + information
- Received May 23, 2013
- Revision received October 23, 2013
- Accepted October 23, 2013
- Published online January 1, 2014.
- Shinji Inaba, MD∗,†,
- Gary S. Mintz, MD∗,
- Naim Z. Farhat, MD‡,
- Jean Fajadet, MD§,
- Dariusz Dudek, MD‖,
- Antonio Marzocchi, MD¶,
- Barry Templin, MBA#,
- Giora Weisz, MD∗,†,
- Ke Xu, PhD∗,
- Bernard de Bruyne, MD, PhD∗∗,
- Patrick W. Serruys, MD, PhD††,
- Gregg W. Stone, MD∗,† and
- Akiko Maehara, MD∗,†∗ ()
- ∗Cardiovascular Research Foundation, New York, New York
- †Columbia University Medical Center, New York, New York
- ‡North Ohio Heart Center/Elyria Memorial Hospital Regional Medical Center, Elyria, Ohio
- §Clinique Pasteur, Toulouse, France
- ‖Jagiellonian University Medical College, Krakow, Poland
- ¶Policlinico Universitario S. Orsola-Malpighi, Bologna, Italy
- #Abbott Vascular, Santa Clara, California
- ∗∗Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- ††Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
- ↵∗Reprint requests and correspondence:
Dr. Akiko Maehara, Columbia University Medical Center/The Cardiovascular Research Foundation, 111 East 59th Street, 12th Floor, New York, New York 10022.
Objectives 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)
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.
- Received May 23, 2013.
- Revision received October 23, 2013.
- Accepted October 23, 2013.
- American College of Cardiology Foundation