PROSPECT: Progression of some thin-cap fibroatheromas associated with increased adverse events

Approximately 12% of patients with nonculprit lesions developed lesion-related adverse events at three years.

Cardiovascular Research Technologies 2010

Identification and characterization of vulnerable plaques in patients with acute coronary syndromes may help in predicting future adverse events, according to PROSPECT study results.

The results were presented at Cardiovascular Research Technologies in Washington, D.C.

Researchers enrolled 700 patients presenting with ACS who were undergoing percutaneous coronary intervention in one or two major coronary arteries. Culprit arteries, followed by nonculprit arteries, were imaged using angiography, IVUS and virtual histology. (A subset of approximately 350 patients was also assessed with palpography.) Patients with events underwent repeat imaging. All were followed up at one month, six months, one year and two years.

According to the study results, 12.9% of a composite of major adverse CV events were culprit lesion–related vs. 11.6% related to nonculprit lesions. Following a Cox proportional hazards regression analysis, the researchers reported that plaque burden at the minimal lumen area ≥70% (HR=5.03; 95% CI, 2.51-10.11); thin-cap fibroatheroma assessed by virtual histology (HR=3.35; 95% CI, 1.77-6.36); and minimal lumen area ≤4.0 mm² (HR=3.21; 95% CI, 1.61-6.42) were all independent predictors of nonculprit lesion–related events. They also reported that the number of predictive factors present correlated with higher rates of nonculprit lesion–related events, with zero factors present associated with a rate of 0.3%; one factor, 4.8%; two factors, 10.5%; and all three predictive factors, 18.2%. The presence of virtual histology thin-cap fibroatheromas combined with any of the predictors was also associated with higher adverse event rates (P<.0001 for all combinations).

“The prospective identification of nonculprit lesions prone to develop major adverse CV events within three years can be enhanced by characterization of underlying plaque morphology with virtual histology, with virtual histology thin-cap fibroatheromas representing the highest-risk lesion type,” Gregg W. Stone, MD, a cardiologist at Columbia University Medical Center in New York, concluded during his presentation. “The combination of large plaque burden and a large necrotic core without a visible cap identifies lesions that are at especially high risk for future adverse CV events.” – by Eric Raible

For more information:

Stone G. Presented at: Cardiovascular Research Technologies; Feb. 21-23; Washington, D.C.

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