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Published on: August 28, 2018
Relationship between palpography and virtual histology in patients with acute coronary syndromes
Salvatore Brugaletta1, Hector M Garcia-Garcia, Patrick W Serruys
1Erasmus University, Thoraxcentrum, Rotterdam, the Netherlands.
Insights
This study found that palpography did not improve the identification of high-risk coronary plaques after acute coronary syndrome. Current imaging methods are insufficient for predicting major adverse cardiac events (MACE) in these patients.
Area of Science:
- Cardiology
- Medical Imaging
- Atherosclerosis Research
Background:
- Fibroatheroma, a specific plaque morphology, is associated with the highest risk of adverse cardiac events.
- Palpography offers potential for assessing local mechanical plaque properties to identify high-risk rupture-prone fibroatheroma.
Purpose of the Study:
- To correlate long-term adverse events post-acute coronary syndrome with coronary plaque characteristics.
- To evaluate mechanical and compositional plaque properties using intravascular ultrasound virtual histology and palpography.
Main Methods:
- 114 patients from the PROSPECT trial underwent simultaneous intravascular ultrasound virtual histology and palpography.
- Coronary plaque characteristics and major adverse cardiac events (MACE) were assessed over a median 3.4-year follow-up.
- MACE were adjudicated to culprit versus untreated nonculprit lesions.
Main Results:
- Larger fibroatheroma size was observed in patients who experienced MACE compared to MACE-free patients (p=0.03).
- Palpography strain values did not differ between fibroatheroma subtypes in patients with or without MACE.
- No significant difference in palpography-derived mechanical properties was found for predicting MACE.
Conclusions:
- Palpography did not provide additional diagnostic value for identifying high-risk fibroatheroma prone to rupture and MACE.
- In patients with acute coronary syndrome treated with contemporary therapies, palpography is not superior to existing methods for predicting long-term MACE.
Objectives:
The purpose of this study was to correlate adverse events at long-term follow-up in patients after an acute coronary syndrome with coronary plaque characteristics derived from simultaneous evaluation of their mechanical and compositional properties using virtual histology (intravascular ultrasound virtual histology) and palpography.
Background:
Fibroatheroma is the plaque morphology with the highest risk of causing adverse cardiac events. Palpography can potentially assess the local mechanical plaque properties with the possibility of identifying fibroatheroma with the highest risk of rupture.
Methods:
A total of 114 patients with acute coronary syndrome from the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) trial underwent a single ultrasound imaging investigation of their 3 coronary vessels with the co-registration of intravascular ultrasound virtual histology and palpography. Major adverse cardiac events (MACE) (cardiac death, cardiac arrest, myocardial infarction, or unstable or progressive angina) were collected up to a median follow-up of 3.4 years and adjudicated to originally treated culprit versus untreated nonculprit lesions.
Results:
In total, 488 necrotic core-rich plaques were identified and subclassified as thin-cap fibroatheroma (n = 111), calcified thick-cap fibroatheroma (n = 213), and noncalcified thick-cap fibroatheroma (n = 164) and matched to their co-registered palpography data. A total of 16 MACE, adjudicated to untreated nonculprit lesions, were recorded at follow-up. In patients in whom MACE developed, fibroatheroma were larger (plaque area 10.0 mm(2) [range: 8.4 to 11.6 mm(2)] vs. 8.2 mm(2) [range: 7.7 to 8.8 mm(2)] (p = 0.03) compared with patients who were MACE free. By palpography, the maximum and the density strain values did not differ between the varying subtypes of fibroatheroma of patients with or without MACE during follow-up.
Conclusions:
In acute coronary syndromes, patients treated with stents and contemporary pharmacotherapy, palpography did not provide additional diagnostic information for the identification of fibroatheroma with a high risk of rupture and MACE during long-term follow-up. (Providing Regional Observations to Study Predictors of Events in the Coronary Tree [PROSPECT]: An Imaging Study in Patients With Unstable Atherosclerotic Lesions; NCT00180466).
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