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PROSPECT: Major adverse CV events after PCI in patients with ACS attributed to culprit, nonculprit lesions

Stone G. N Engl J Med. 2011;364:226-235.

Issue: March 2011

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Data from the PROSPECT trial have indicated that major adverse CV events occurring in patients with acute coronary syndrome who underwent percutaneous coronary intervention were the result of culprit and nonculprit lesions equally.

“The primary purpose of this natural-history study was to provide prospective in vivo confirmation of the hypothesis that ACS arise from atheromas with certain histopathological characteristics, and that these characteristics are not necessarily dependent on the degree of angiographic stenosis at that site,” the researchers wrote. “Although most of the lesions responsible for major adverse CV events during follow-up were angiographically mild, intravascular ultrasonography showed that most had either a small luminal area, a large plaque burden, or both — findings that are consistent with the results of pathological studies.”

The Providing Regional Observations to Study Predictors of Events in the Coronary Tree (PROSPECT) trial featured 697 patients with ACS. After PCI, all patients underwent three-vessel coronary angiography and gray-scale and radiofrequency IVUS (Eagle Eye, In-Vision Gold; Volcano) imaging.

After a median follow-up of 3.4 years, researchers reported a 3-year rate of major adverse CV events of 20.4%, which researchers reported was related to culprit lesions in 12.9% of patients and nonculprit lesions in 11.6%.

Furthermore, nonculprit lesions were predominately mild at baseline. After multivariate analysis, nonculprit lesions that were associated with recurrent events were more likely than those not associated to be characterized by plaque burden of at least 70% (HR=5.03; 95% CI, 2.51-10.11), a minimal luminal area of 4 mm² or less (HR=3.21; 95% CI, 1.61-6.42), or to be classified by radiofrequency intravascular ultrasonography as thin-cap fibroatheromas (HR=3.35; 95% CI, 1.77-6.36).

Initial Cardiology Today coverage of the PROSPECT trial from Cardiovascular Research Technologies 2010 can be viewed here.

The trial was funded by Abbott Vascular and Volcano.

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