Abstract 10148: In-vivo Detection of High Risk Coronary Plaques by Intravascular Ultrasound and 1-year Cardiovascular Outcome in Patients Undergoing Coronary Angiography
Background: Acute coronary syndromes (ACS) are mostly caused by plaque rupture. This study (ATHEROREMO-IVUS study) aims to investigate the prognostic value of in-vivo detection of high risk coronary plaques by intravascular ultrasound (IVUS) in patients undergoing coronary catheterization.
Methods and Results: Between 2008 and 2011, IVUS of a non-culprit coronary artery was performed in 581 patients who underwent coronary angiography for ACS (n=318) or stable angina pectoris (n=263). Primary endpoint was 1-year major adverse cardiac events (MACE), defined as all-cause mortality, ACS or unplanned coronary revascularization. Culprit lesion-related MACE were not counted. The presence of thin-cap fibroatheroma (TCFA) lesions (present 10.8% MACE vs. absent 5.6%; adjusted HR1.98, 95%CI 1.09-3.60; p=0.026) and lesions with a plaque burden of ≥70% (present 16.2% MACE vs. absent 5.5%; adjusted HR2.90, 95%CI 1.60-5.25; p<0.001) were independently associated with higher MACE rate. The MACE rate was increased even further when patients had a TCFA lesion with a minimal luminal area of 4.0 mm2 or less, a plaque burden of ≥70%, or a combination thereof (Figure). TCFA lesions were also independently associated with the composite of death or ACS only (present 7.5% vs. absent 3.0%; adjusted HR 2.51, 95%CI 1.15-5.49; p=0.021). TCFA lesions with a plaque burden of ≥70% were associated with higher MACE rate within (p=0.011) and after (p<0.001) 6 months of follow-up, while smaller TCFA lesions were only associated with higher MACE rate after 6 months (p=0.033).
Conclusions: In patients undergoing coronary angiography, the presence of IVUS-derived TCFA lesions in a non-culprit coronary artery is strongly and independently predictive for occurrence of MACE, particularly of death and ACS. TCFA lesions with a large plaque burden carry higher risk than small TCFA lesions, especially on the short term.
- © 2013 by American Heart Association, Inc.