Anne-Sophie Schuurman1, Maxime M Vroegindewey1, Isabella Kardys1, Rohit M Oemrawsingh2, Hector M Garcia-Garcia3, Robert-Jan van Geuns4, Evelyn Regar5, Nicolas M Van Mieghem1, Jurgen Ligthart6, Patrick W Serruys7, Eric Boersma1, K Martijn Akkerhuis8. 1. Department of Cardiology, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands; Cardiovascular Research School COEUR, Erasmus MC University Medical Center, Rotterdam, the Netherlands. 2. Department of Cardiology, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands; Cardiovascular Research School COEUR, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Cardiology, Amphia Hospital, Breda, the Netherlands. 3. Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC. 4. Department of Cardiology, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands; Cardiovascular Research School COEUR, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands. 5. Department of Cardiology, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands; Cardiovascular Research School COEUR, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland. 6. Department of Cardiology, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands. 7. Department of Cardiology, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands; Imperial College, London, United Kingdom. 8. Department of Cardiology, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands; Cardiovascular Research School COEUR, Erasmus MC University Medical Center, Rotterdam, the Netherlands. Electronic address: k.m.akkerhuis@erasmusmc.nl.
Abstract
BACKGROUND: It has been shown that intravascular ultrasound (IVUS) and radiofrequency (RF-)IVUS can detect high-risk coronary plaque characteristics. OBJECTIVES: The authors studied the long-term prognostic value of (RF-)IVUS-derived plaque characteristics in patients with coronary artery disease (CAD) undergoing coronary angiography. METHODS: From 2008 to 2011, (RF-)IVUS was performed in 1 nonstenotic segment of a nonculprit coronary artery in 581 patients undergoing coronary angiography for acute coronary syndrome (ACS) or stable angina. The pre-defined primary endpoint was major adverse cardiovascular events (MACE), defined as the composite of all-cause death, nonfatal ACS, or unplanned revascularization. Hazard ratios (HRs) were adjusted for age, sex, and clinical risk factors. RESULTS: During a median follow-up of 4.7 years, 152 patients (26.2%) had MACE. The presence of a lesion with a minimal luminal area ≤4.0 mm2 was independently associated with MACE (HR: 1.49; 95% CI: 1.07 to 2.08; p = 0.020), whereas the presence of a thin-cap fibroatheroma lesion or a lesion with a plaque burden ≥70% on its own were not. Results were comparable when the composite endpoint included cardiac death instead of all-cause death. The presence of a lesion with a plaque burden of ≥70% was independently associated with the composite endpoint of cardiac death, nonfatal ACS, or unplanned revascularization after exclusion of culprit lesion-related events (HR: 1.66; 95% CI: 1.06 to 2.58; p = 0.026). Likewise, each 10-U increase in segmental plaque burden was independently associated with a 26% increase in risk of this composite endpoint (HR: 1.26 per 10-U increase; 95% CI: 1.03 to 1.52; p = 0.022). CONCLUSIONS: IVUS-derived small luminal area and large plaque burden, and not RF-IVUS-derived compositional plaque features on their own, predict adverse cardiovascular outcome during long-term follow-up in patients with CAD. (The European Collaborative Project on Inflammation and Vascular Wall Remodeling in Atherosclerosis-Intravascular Ultrasound Study [AtheroRemoIVUS]; NCT01789411).
BACKGROUND: It has been shown that intravascular ultrasound (IVUS) and radiofrequency (RF-)IVUS can detect high-risk coronary plaque characteristics. OBJECTIVES: The authors studied the long-term prognostic value of (RF-)IVUS-derived plaque characteristics in patients with coronary artery disease (CAD) undergoing coronary angiography. METHODS: From 2008 to 2011, (RF-)IVUS was performed in 1 nonstenotic segment of a nonculprit coronary artery in 581 patients undergoing coronary angiography for acute coronary syndrome (ACS) or stable angina. The pre-defined primary endpoint was major adverse cardiovascular events (MACE), defined as the composite of all-cause death, nonfatal ACS, or unplanned revascularization. Hazard ratios (HRs) were adjusted for age, sex, and clinical risk factors. RESULTS: During a median follow-up of 4.7 years, 152 patients (26.2%) had MACE. The presence of a lesion with a minimal luminal area ≤4.0 mm2 was independently associated with MACE (HR: 1.49; 95% CI: 1.07 to 2.08; p = 0.020), whereas the presence of a thin-cap fibroatheroma lesion or a lesion with a plaque burden ≥70% on its own were not. Results were comparable when the composite endpoint included cardiac death instead of all-cause death. The presence of a lesion with a plaque burden of ≥70% was independently associated with the composite endpoint of cardiac death, nonfatal ACS, or unplanned revascularization after exclusion of culprit lesion-related events (HR: 1.66; 95% CI: 1.06 to 2.58; p = 0.026). Likewise, each 10-U increase in segmental plaque burden was independently associated with a 26% increase in risk of this composite endpoint (HR: 1.26 per 10-U increase; 95% CI: 1.03 to 1.52; p = 0.022). CONCLUSIONS: IVUS-derived small luminal area and large plaque burden, and not RF-IVUS-derived compositional plaque features on their own, predict adverse cardiovascular outcome during long-term follow-up in patients with CAD. (The European Collaborative Project on Inflammation and Vascular Wall Remodeling in Atherosclerosis-Intravascular Ultrasound Study [AtheroRemoIVUS]; NCT01789411).
Authors: Jeremy Yuvaraj; Andrew Lin; Nitesh Nerlekar; Ravi K Munnur; James D Cameron; Damini Dey; Stephen J Nicholls; Dennis T L Wong Journal: Cells Date: 2021-05-10 Impact factor: 6.600