Elsevier

JACC: Cardiovascular Imaging

Volume 6, Issue 12, December 2013, Pages 1263-1272
JACC: Cardiovascular Imaging

Original Research
Clinical and Angiographic Characteristics of Patients Likely to Have Vulnerable Plaques: Analysis From the PROSPECT Study

https://doi.org/10.1016/j.jcmg.2013.04.015Get rights and content
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Objectives

This study sought to determine the clinical and angiographic variables that would identify patients with high-risk “vulnerable” coronary plaques.

Background

In the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study, in patients successfully treated for acute coronary syndrome (ACS), plaque composition, plaque burden, and minimal luminal area as detected by 3-vessel radiofrequency intravascular ultrasound (IVUS) imaging were associated with an increased risk of developing future events from untreated atherosclerotic lesions (vulnerable plaques). Whether baseline demographic and angiographic findings can be used to identify patients most likely to have vulnerable coronary plaques has not been examined.

Methods

On the basis of 3-vessel radiofrequency IVUS imaging, patents in the PROSPECT trial were classified in 2 groups according to whether or not one or more untreated high-risk plaques were present, defined as having ≥2 high-risk features (a thin-cap fibroatheroma, plaque burden ≥70%, and/or minimal luminal area ≤4 mm2).

Results

The high-risk group (those with one or more high-risk lesions) had higher Framingham risk score (7.5 ± 3.4 vs. 6.9 ± 3.3; p = 0.04), more extensive coronary artery disease, and more nonculprit lesion–related cardiovascular events during the 3-year follow-up (hazard ratio: 2.63; 95% confidence interval: 1.62 to 3.66; p < 0.0001). However, demographic factors had poor discrimination in detecting high-risk patients (area under the curve 0.55), and discrimination was only slightly improved when angiographic variables were entered into the model (area under the curve 0.64).

Conclusions

Clinical and angiographic characteristics had poor predictive accuracy in identifying patients with untreated high-risk plaques related to future adverse events. This finding highlights the potential value of comprehensive 3-vessel imaging assessment (either invasive or noninvasive) to evaluate plaque phenotype for more accurate risk stratification of patients admitted with ACS.

Key Words

cardiovascular events
coronary angiography
intravascular ultrasound

Abbreviations and Acronyms

ACS
acute coronary syndrome
CRP
C-reactive protein
EEM
external elastic membrane
IVUS
intravascular ultrasound
MACE
major adverse cardiac events
MLA
minimum lumen area
QCA
quantitative coronary angiography
TCFA
thin-cap fibroatheroma
VH
virtual histology

Cited by (0)

Dr. Bourantas is funded by the Hellenic Heart Foundation (ELIKAR), Athens, Greece. Dr. Maehara has received research grants from and served as a consultant to Boston Scientific. Dr. Weisz has served as a consultant to InfraReDx. Dr. Stone has served as a consultant to Volcano and InfraReDx. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. H. William Strauss, MD, served as Guest Editor for this paper.