Abstract 2510: Culprit Lesion Remodeling Affects Long-Term Clinical Outcome in Patients with Acute Coronary Syndrome: A Prospective, Multicenter Three-Vessel Intravascular Ultrasound Study
Single center studies have shown that plaque rupture and positive remodeling are prognostic predictors of acute coronary syndrome (ACS). A total of 119 patients with first ACS events were enrolled in a multicenter, prospective, 3-vessel intravascular ultrasound (IVUS) registry. Pre-intervention IVUS imaging was performed in 98 patients. Remodeling index was defined as lesion site external elastic membrane cross sectional area (EEM CSA) divided by the proximal reference. Arterial remodeling was defined as either positive (PR; remodeling index >1.05) or intermediate/negative (IR/NR; remodeling index <1.05). Plaque rupture was a cavity that communicated with the lumen with an overlying residual fibrous cap fragment. Major adverse cardiac events (MACE) were death, myocardial infarction (MI), and target lesion revascularization (TLR). During follow-up (mean 3 years), 20 TLR events and 5 deaths were documented; but recurrent MI was not observed. Patients with PR had significantly lower MACE-free survival than patients with IR/NR (Log rank, p=0.03). Similarly, patients with plaque rupture showed a non-significant trend toward lower MACE-free survival (Log rank, p=0.13). By multivariate logistic regression analysis, culprit lesion PR was the only independent predictor of follow-up MACE. Culprit lesion remodeling is a strong predictor of long-term clinical outcome in patients with ACS.