Author + information
- Received March 18, 2015
- Revision received June 9, 2015
- Accepted June 14, 2015
- Published online October 1, 2015.
- Bo Zheng, MD∗,†,‡,
- Gary S. Mintz, MD†,
- John A. McPherson, MD§,
- Bernard De Bruyne, MD, PhD‖,
- Naim Z. Farhat, MD¶,
- Steven P. Marso, MD#,
- Patrick W. Serruys, MD, PhD∗∗,
- Gregg W. Stone, MD∗,† and
- Akiko Maehara, MD∗,†∗ ()
- ∗New York–Presbyterian/Columbia University Medical Center, New York, New York
- †Cardiovascular Research Foundation, New York, New York
- ‡Peking University First Hospital, Beijing, China
- §Vanderbilt University School of Medicine, Nashville, Tennessee
- ‖Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- ¶North Ohio Heart Center/Elyria Memorial Hospital Regional Medical Center, Elyria, Ohio
- #University of Texas Southwestern Medical Center, Dallas, Texas
- ∗∗Erasmus Medical Center, Rotterdam, the Netherlands
- ↵∗Reprint requests and correspondence:
Dr. Akiko Maehara, Cardiovascular Research Foundation, 111 East 59th Street, 12th Floor, New York, New York 10022.
Objectives The study sought to examine the relative importance of lesion location versus vessel area and plaque burden in predicting plaque rupture within nonculprit fibroatheromas (FAs) in patients with acute coronary syndromes.
Background Previous studies have demonstrated that plaque rupture is associated with larger vessel area and greater plaque burden clustering in the proximal segments of coronary arteries.
Methods In the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study 3-vessel grayscale and radiofrequency-intravascular ultrasound was performed after successful percutaneous coronary intervention in 697 patients with acute coronary syndromes. Untreated nonculprit lesion FAs were classified as proximal (<20 mm), mid (20 to 40 mm), and distal (>40 mm) according to the distance from the ostium to the maximum necrotic core site.
Results Overall, 74 ruptured FAs and 2,396 nonruptured FAs were identified in nonculprit vessels. The majority of FAs (73.6%) were located within 40 mm of the ostium, and the vessel area and plaque burden progressively decreased from proximal to distal FA location (both p < 0.001). In a multivariate logistic regression model, independent predictors for plaque rupture included the distance from the ostium to the maximum necrotic core site per millimeter (odds ratio [OR]: 0.86; 95% confidence interval [CI]: 0.76 to 0.98; p = 0.02), plaque burden per 10% (OR: 2.05; 95% CI: 1.63 to 2.58; p < 0.0001), vessel area per mm2 (OR: 1.14; 95% CI: 1.11 to 1.17; p < 0.0001), calcium (OR: 0.09; 95% CI: 0.05 to 0.18; p < 0.0001), and right coronary artery location (OR: 2.16; 95% CI: 1.25 to 3.27; p = 0.006). By receiver-operating characteristic analysis, vessel area correlated with plaque rupture stronger than either plaque burden (p < 0.001) or location (p < 0.001).
Conclusions Large vessel area, plaque burden, proximal location, right coronary artery location, and lack of calcium were associated with FA plaque rupture. The present study suggests that among these variables, vessel area may be the strongest predictor of plaque rupture among non–left main coronary arteries. (PROSPECT: An Imaging Study in Patients With Unstable Atherosclerotic Lesions [PROSPECT]; NCT00180466)
Dr. Zheng has received a research grant from Boston Scientific. Dr. Mintz is a consultant for Volcano Corporation, Boston Scientific, InfraReDx, and ACIST; has received fellowship/grant support from Volcano Corporation, Boston Scientific, and InfraReDx; and has received honoraria from Boston Scientific, InfraReDx, and ACIST. Dr. McPherson has received consultant fees from Cardiox, Inc., Healthwise, Inc., and Velomedix Inc. Dr. De Bruyne's institution receives grant support and consulting fees on his behalf from St. Jude Medical. Dr. Marso is a consultant for St. Jude Medical, Novo Nordisk, and The Medicines Company; and has received research grants from Bristol-Myers Squibb, Novo Nordisk, Terumo, The Medicines Company, and Volcano Corporation. Dr. Maehara has received grant support from Boston Scientific; is a consultant for ACIST and Boston Scientific; and has received speaker fees from St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. H. Vernon Anderson, MD, served as Guest Editor for this paper.
- Received March 18, 2015.
- Revision received June 9, 2015.
- Accepted June 14, 2015.
- American College of Cardiology Foundation