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Adverse cardiovascular events arising from atherosclerotic lesions with and without angiographic disease progression
Elias A Sanidas1, Gary S Mintz, Akiko Maehara
1Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York 10022, USA.
Insights
Vulnerable plaque progression in nonculprit coronary lesions can lead to adverse events, with substantial lesion progression (SLP) associated with myocardial infarctions. However, events without SLP also occurred, highlighting the complexity of coronary artery disease progression.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Vulnerable plaque progression is a key factor in acute coronary syndromes.
- The natural history of nonculprit coronary lesions is crucial for understanding future cardiovascular events.
Purpose of the Study:
- To assess coronary lesions using angiography and intravascular ultrasound-virtual histology.
- To evaluate the progression of nonculprit lesions over a median follow-up of 3.4 years.
- To differentiate events associated with substantial lesion progression (SLP) from those without.
Main Methods:
- The PROSPECT study enrolled 697 patients with acute coronary syndromes.
- Three-vessel imaging was performed to analyze culprit and nonculprit (NC) lesions.
- NC lesions were categorized based on the presence or absence of substantial lesion progression (SLP).
Main Results:
- Of 72 events from NC lesions, 61% had SLP, and 39% did not.
- Myocardial infarctions occurred exclusively in patients with SLP.
- Lesions with SLP were less severe at baseline but more stenotic at the time of the event, with a delayed onset.
Conclusions:
- Nonculprit lesions causing future cardiovascular events demonstrated angiographic progression over 3.4 years.
- Substantial lesion progression underlies many, but not all, nonculprit lesion events.
- Events with SLP were characterized by less initial severity and a delayed time course.
Objectives:
The aim of this study was to use angiography and grayscale and intravascular ultrasound-virtual histology to assess coronary lesions that caused events during a median follow-up period of 3.4 years.
Background:
Vulnerable plaque-related events are assumed to be the result of substantial progression of insignificant lesions.
Methods:
In the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study, 697 patients with acute coronary syndromes underwent treatment of all culprit lesions followed by 3-vessel imaging to assess the natural history of culprit and untreated nonculprit (NC) lesions. Future adverse cardiovascular events adjudicated to NC lesions were divided into those with versus without substantial lesion progression (SLP) (≥ 20% angiographic diameter stenosis increase).
Results:
NC lesion events occurred in 72 patients, 44 (61%) with and 28 (39%) without SLP. Myocardial infarctions (n = 6) occurred only in patients with SLP. Conversely, patients without SLP presented only with unstable or increasing angina requiring rehospitalization. Lesions with versus without SLP occurred later (median time to event 401 vs. 223 days, p = 0.07); were less severe at baseline (median diameter stenosis 26.4% vs. 53.8%, p < 0.0001) but more severe at the time of the event (mean diameter stenosis 73.8% vs. 56%, p < 0.0001); and had comparable baseline median plaque burden (68.7% vs. 70.1%, p = 0.17), minimum luminal area (3.7 vs. 4.0 mm(2), p = 0.60), and intravascular ultrasound-virtual histology phenotype (83.3% vs. 90.9%, p = 0.68; classified as fibroatheromas at baseline).
Conclusions:
NC lesions responsible for future cardiovascular events showed angiographic increase during 3.4 years of follow-up, whereas SLP underlay many but not all of them. NC events due to lesions with SLP were angiographically less severe and presented with a delayed time course but were otherwise indistinguishable from NC events that were not associated with SLP.
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