Related Experiment Video
Updated: Jun 5, 2026
Optical Coherence Tomography Based Biomechanical Fluid-Structure Interaction Analysis of Coronary Atherosclerosis Progression
Published on: January 15, 2022
A prospective natural-history study of coronary atherosclerosis
Gregg W Stone1, Akiko Maehara, Alexandra J Lansky
1Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY 10022, USA. gs2184@columbia.edu
Insights
Major adverse cardiovascular events after acute coronary syndromes are equally caused by treated and untreated lesions. Untreated lesions, even if mild, pose significant risk if they have large plaque burden or are thin-cap fibroatheromas.
Area of Science:
- Cardiology
- Vascular Biology
- Interventional Cardiology
Background:
- Acute coronary syndromes (ACS) often arise from mild coronary artery stenosis.
- Risk factors for these events at lesion sites remain poorly understood.
Purpose of the Study:
- To investigate the characteristics of culprit and non-culprit lesions associated with major adverse cardiovascular events (MACE) in ACS patients post-percutaneous coronary intervention (PCI).
Main Methods:
- Prospective study of 697 ACS patients undergoing coronary angiography and intravascular ultrasound (IVUS) post-PCI.
- Adjudication of MACE (cardiac death, arrest, MI, unstable angina rehospitalization) related to culprit or non-culprit lesions over a median 3.4-year follow-up.
Main Results:
- 3-year cumulative MACE rate was 20.4%, with events linked to culprit lesions (12.9%) and non-culprit lesions (11.6%) occurring equally.
- Non-culprit lesions causing events were often angiographically mild (32.3% stenosis) but characterized by high plaque burden (≥70%), small minimal luminal area (≤4.0 mm²), or thin-cap fibroatheroma (TCFA) on IVUS.
Conclusions:
- MACE in ACS patients post-PCI are equally attributed to culprit and non-culprit lesions.
- Angiographically mild non-culprit lesions responsible for events frequently exhibit high plaque burden, small luminal area, or are TCFAs, detectable by IVUS.
Background:
Atherosclerotic plaques that lead to acute coronary syndromes often occur at sites of angiographically mild coronary-artery stenosis. Lesion-related risk factors for such events are poorly understood.
Methods:
In a prospective study, 697 patients with acute coronary syndromes underwent three-vessel coronary angiography and gray-scale and radiofrequency intravascular ultrasonographic imaging after percutaneous coronary intervention. Subsequent major adverse cardiovascular events (death from cardiac causes, cardiac arrest, myocardial infarction, or rehospitalization due to unstable or progressive angina) were adjudicated to be related to either originally treated (culprit) lesions or untreated (nonculprit) lesions. The median follow-up period was 3.4 years.
Results:
The 3-year cumulative rate of major adverse cardiovascular events was 20.4%. Events were adjudicated to be related to culprit lesions in 12.9% of patients and to nonculprit lesions in 11.6%. Most nonculprit lesions responsible for follow-up events were angiographically mild at baseline (mean [±SD] diameter stenosis, 32.3±20.6%). However, on multivariate analysis, nonculprit lesions associated with recurrent events were more likely than those not associated with recurrent events to be characterized by a plaque burden of 70% or greater (hazard ratio, 5.03; 95% confidence interval [CI], 2.51 to 10.11; P<0.001) or a minimal luminal area of 4.0 mm(2) or less (hazard ratio, 3.21; 95% CI, 1.61 to 6.42; P=0.001) or to be classified on the basis of radiofrequency intravascular ultrasonography as thin-cap fibroatheromas (hazard ratio, 3.35; 95% CI, 1.77 to 6.36; P<0.001).
Conclusions:
In patients who presented with an acute coronary syndrome and underwent percutaneous coronary intervention, major adverse cardiovascular events occurring during follow-up were equally attributable to recurrence at the site of culprit lesions and to nonculprit lesions. Although nonculprit lesions that were responsible for unanticipated events were frequently angiographically mild, most were thin-cap fibroatheromas or were characterized by a large plaque burden, a small luminal area, or some combination of these characteristics, as determined by gray-scale and radiofrequency intravascular ultrasonography. (Funded by Abbott Vascular and Volcano; ClinicalTrials.gov number, NCT00180466.).
Related Concept Videos
01:30Coronary Artery Disease I: Introduction
01:27Atherosclerosis II: Clinical Manifestations and Diagnostic Tests
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:26Coronary Artery Disease II: Pathophysiology
01:27Coronary Artery Disease V: Interprofessional Care
01:26Coronary Artery Disease IV: Preventive Measures