CLINICAL: VH IVUS Clinical Paper Summaries

VH IVUS / PROSPECT

• 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 %).