Clinical Outcome of Nonculprit Plaque Ruptures in Patients With Acute Coronary Syndrome in the PROSPECT Study

• Published in: JACC. Cardiovascular imaging 2014-04, Vol.7 (4), p.397-405
• Main Authors: Xie, Yong, MD, Mintz, Gary S., MD, Yang, Junqing, MD, Doi, Hiroshi, MD, PhD, Iñiguez, Andrés, MD, Dangas, George D., MD, PhD, Serruys, Patrick W., MD, PhD, McPherson, John A., MD, Wennerblom, Bertil, MD, Xu, Ke, PhD, Weisz, Giora, MD, Stone, Gregg W., MD, Maehara, Akiko, MD
• Format: Article
• Language: English
• Subjects: Acute Coronary Syndrome - diagnosis; Acute Coronary Syndrome - etiology; Acute Coronary Syndrome - therapy; Aged; Cardiovascular; Chi-Square Distribution; Coronary Angiography; Coronary Artery Disease - complications; Coronary Artery Disease - diagnosis; Coronary Artery Disease - therapy; Coronary Thrombosis - diagnosis; Coronary Thrombosis - etiology; Coronary Thrombosis - therapy; Coronary Vessels - diagnostic imaging; Coronary Vessels - pathology; Female; Humans; Least-Squares Analysis; Logistic Models; Male; Middle Aged; Multimodal Imaging - methods; Multivariate Analysis; Necrosis; Odds Ratio; Percutaneous Coronary Intervention - instrumentation; Plaque, Atherosclerotic; Predictive Value of Tests; Prospective Studies; Risk Factors; Rupture, Spontaneous; Stents; Time Factors; Treatment Outcome; Ultrasonography, Interventional
• ISSN: 1936-878X; 1876-7591
• DOI: 10.1016/j.jcmg.2013.10.010

Objectives The aim of this study was to report the frequency, patient and lesion-related characteristics, and outcomes of subclinical, nonculprit plaque ruptures in the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study. Background Plaque rupture and subsequent thrombosis is the most common cause of acute coronary syndrome (ACS). Secondary, subclinical, nonculprit plaque ruptures have been seen in both stable patients and patients with ACS; however, reports of the natural history of these secondary plaque ruptures are limited. Methods After successful stenting in 697 patients with ACS, 3-vessel grayscale and intravascular ultrasound virtual histology (IVUS-VH) was performed in the proximal-mid segments of all 3 coronary arteries as part of a prospective multicenter study. Results Among 660 patients with complete IVUS data, 128 plaque ruptures were identified in 105 nonculprit lesions in 100 arteries from 93 patients (14.1%). Although the minimum lumen area (MLA) was similar, the plaque burden was significantly greater in nonculprit lesions with a plaque rupture compared with nonculprit lesions without a plaque rupture (66.0% [95% confidence interval: 64.5% to 67.4%] vs. 56.0% [95% confidence interval: 55.6% to 56.4%]; p