Relationship between left main coronary artery plaque burden and nonleft main coronary atherosclerosis: results from
Takehisa Shimizu1,2, Gary S Mintz2, Bernard De Bruyne3
1Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center.
Insights
Left main coronary artery (LMCA) plaque burden reflects overall coronary atherosclerosis severity and predicts high-risk plaques. Higher LMCA plaque burden is associated with increased non-LMCA atheroma volume and adverse cardiac events.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Atherosclerosis Research
Background:
- The relationship between left main coronary artery (LMCA) disease severity and overall coronary atherosclerotic burden is not well understood.
- Assessing LMCA disease characteristics can provide insights into systemic atherosclerosis.
Purpose of the Study:
- To evaluate LMCA disease characteristics in patients with acute coronary syndromes.
- To determine the association between LMCA plaque burden and atherosclerosis in other coronary arteries.
- To investigate the impact of LMCA plaque burden on patient outcomes.
Main Methods:
- The PROSPECT study enrolled 697 patients with acute coronary syndromes.
- Three-vessel intravascular ultrasound (IVUS) was performed post-percutaneous coronary intervention.
- 552 patients with adequate LMCA imaging were analyzed based on LMCA plaque burden.
Main Results:
- Higher LMCA plaque burden correlated with smaller LMCA lumen area and greater necrotic core volume.
- Increased LMCA plaque burden was significantly associated with higher overall non-LMCA atheroma volume.
- LMCA plaque burden independently predicted non-LMCA atheroma volume and was linked to the presence of PROSPECT risk predictors for MACE.
Conclusions:
- LMCA atherosclerosis severity is a predictor of overall coronary atherosclerotic burden.
- High-risk plaques in major epicardial arteries are associated with LMCA plaque burden.
- LMCA plaque burden reflects the extent of atherosclerosis in the entire coronary tree.
Objectives:
Whether the severity of left main coronary artery (LMCA) disease reflects LMCA and overall coronary atherosclerotic burden is not known. We aimed to assess nonculprit LMCA disease characteristics and the relationship with atherosclerosis in the rest of the coronary arteries as well as patient outcomes.
Patients And Methods:
In the PROSPECT study, 697 patients with acute coronary syndromes underwent three-vessel gray-scale and radiofrequency intravascular ultrasound after percutaneous coronary intervention.
Results:
Overall, 552 patients with adequate LMCA imaging were compared according to LMCA plaque burden. The tertile with the highest plaque burden in the LMCA had the smallest LMCA minimum lumen area (17.4, 14.2, 10.5, lowest through highest tertiles, respectively, P<0.0001) and the greatest percent necrotic core volume (2.8, 5.6, 9.5%, lowest through highest tertiles, respectively, P<0.0001). Furthermore, the tertile with the highest plaque burden was also significantly associated with the highest overall non-LMCA percent atheroma volume within the major epicardial arteries (48.3, 49.2, 50.8%, lowest through highest tertiles, respectively, P<0.0001). After adjusting for patient background, the LMCA plaque burden was independently associated with non-LMCA percent atheroma volume (P=0.003). Of the three PROSPECT predictors of future nonculprit major adverse cardiac events (MACE) (minimum lumen area≤4 mm, plaque burden≥70%, and virtual histology thin-cap fibroatheroma), the tertile with the highest LMCA plaque burden had the highest number of patients with at least one of three PROSPECT predictors (P=0.03). In multivariable model, though total atheroma volume (per 1%) was an independent predictor of all MACE [hazard ratio (95% confidence interval)=1.06 (1.01-1.11), P=0.02] and strong trend for non-culprit-related MACE [hazard ratio (95% confidence interval)=1.06 (1.00-1.13), P=0.06], plaque burden at LMCA was not (all MACE, P=0.90, non-culprit-related MACE, P=0.85).
Conclusion:
The severity of atherosclerosis in LMCA predicted the overall atherosclerotic plaque burden as well as the presence of high-risk plaques in the three major epicardial coronary arteries.
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