VH IVUS / PROSPECT
Providing Regional Observations to Study Predictors of Events in the Coronary Tree (PROSPECT).
Stone GW, Serruys P, de Bruyne B.
Prospective assessment of the event rate attributable to the progression of vulnerable plaque.
- 697 patients
- 40 European and U.S. cen-ters
- IVUS and Virtual Histology post PCI on the 3 primary coronary arteries
- Prospective registry of acute coronary syndromes (ACS) patients
- Approximately 20 % of patients with ACS successfully treated with stents and contemporary medical Rx develop MACE within 3 years.
- Approximately 12 % of patients develop MACE from non culprit lesions during 3 years of follow-up.
- While plaques which are responsible for unanticipated future MACE are frequently angiographically mild, most untreated plaques which become symptomatic have a large plaque burden and a small lumen area.
- The patients had on average 0.83 lesions with < 4 mm² MLA that were left untreated.
- The prospective identification of non culprit lesions prone to develop MACE within 3 years can be enhanced by characterization of underlying plaque morphology with virtual histology, with VH-TCFAs representing the highest risk lesion type.
- In 52 % of the patients at least one VH thin-cap fibroatheroma (TCFA) that was left behind was identified.
- The combination of large plaque burden by IVUS and large necrotic core without visible cap (VH-TCFA) identifies high risk lesions for MACE (15.3 %) within 3 years.
- The combination of large plaque burden by IVUS and pathological intimal thickening (PIT) has a lower risk for MACE within 3 years compared to high plaque burden lesions in general (2.6 % vs. 9.2 %).
The highest risk plaque type is VH thin-cap fibroatheroma (VH-TCFA) with a minimum lumen area of ≤ 4 mm² and a plaque burden ≥ 70 %. The current practice of using angiography alone cannot measure plaque burden or the presence of VH-TCFAs, which were the two most signifi-cant predictors of lesion risk for events within 3 years. The plaque type pathological intimal thickening (PIT) with a plaque burden of ≥ 70 % is associated with a reduced risk of MACE.
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