Clinical and angiographic characteristics of patients likely to have vulnerable plaques: Analysis from the PROSPECT study

Christos V. Bourantas, Hector M. Garcia-Garcia, Vasim Farooq, Akiko Maehara, Ke Xu, Philippe Genereux, Roberto Diletti, Takashi Muramatsu, Martin Fahy, Giora Weisz, Gregg W. Stone, Patrick W. Serruys

Research output: Contribution to journalArticle

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Abstract

Objectives This study sought to determine the clinical and angiographic variables that would identify patients with high-risk "vulnerable" coronary plaques. Background In the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study, in patients successfully treated for acute coronary syndrome (ACS), plaque composition, plaque burden, and minimal luminal area as detected by 3-vessel radiofrequency intravascular ultrasound (IVUS) imaging were associated with an increased risk of developing future events from untreated atherosclerotic lesions (vulnerable plaques). Whether baseline demographic and angiographic findings can be used to identify patients most likely to have vulnerable coronary plaques has not been examined. Methods On the basis of 3-vessel radiofrequency IVUS imaging, patents in the PROSPECT trial were classified in 2 groups according to whether or not one or more untreated high-risk plaques were present, defined as having ≥2 high-risk features (a thin-cap fibroatheroma, plaque burden ≥70%, and/or minimal luminal area ≤4 mm2). Results The high-risk group (those with one or more high-risk lesions) had higher Framingham risk score (7.5 ± 3.4 vs. 6.9 ± 3.3; p = 0.04), more extensive coronary artery disease, and more nonculprit lesion-related cardiovascular events during the 3-year follow-up (hazard ratio: 2.63; 95% confidence interval: 1.62 to 3.66; p < 0.0001). However, demographic factors had poor discrimination in detecting high-risk patients (area under the curve 0.55), and discrimination was only slightly improved when angiographic variables were entered into the model (area under the curve 0.64). Conclusions Clinical and angiographic characteristics had poor predictive accuracy in identifying patients with untreated high-risk plaques related to future adverse events. This finding highlights the potential value of comprehensive 3-vessel imaging assessment (either invasive or noninvasive) to evaluate plaque phenotype for more accurate risk stratification of patients admitted with ACS.

Original languageEnglish (US)
Pages (from-to)1263-1272
Number of pages10
JournalJACC: Cardiovascular Imaging
Volume6
Issue number12
DOIs
StatePublished - Dec 1 2013
Externally publishedYes

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Acute Coronary Syndrome
Area Under Curve
Ultrasonography
Demography
Patents
Atherosclerotic Plaques
Coronary Artery Disease
Confidence Intervals
Phenotype

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Bourantas, Christos V. ; Garcia-Garcia, Hector M. ; Farooq, Vasim ; Maehara, Akiko ; Xu, Ke ; Genereux, Philippe ; Diletti, Roberto ; Muramatsu, Takashi ; Fahy, Martin ; Weisz, Giora ; Stone, Gregg W. ; Serruys, Patrick W. / Clinical and angiographic characteristics of patients likely to have vulnerable plaques : Analysis from the PROSPECT study. In: JACC: Cardiovascular Imaging. 2013 ; Vol. 6, No. 12. pp. 1263-1272.
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title = "Clinical and angiographic characteristics of patients likely to have vulnerable plaques: Analysis from the PROSPECT study",
abstract = "Objectives This study sought to determine the clinical and angiographic variables that would identify patients with high-risk {"}vulnerable{"} coronary plaques. Background In the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study, in patients successfully treated for acute coronary syndrome (ACS), plaque composition, plaque burden, and minimal luminal area as detected by 3-vessel radiofrequency intravascular ultrasound (IVUS) imaging were associated with an increased risk of developing future events from untreated atherosclerotic lesions (vulnerable plaques). Whether baseline demographic and angiographic findings can be used to identify patients most likely to have vulnerable coronary plaques has not been examined. Methods On the basis of 3-vessel radiofrequency IVUS imaging, patents in the PROSPECT trial were classified in 2 groups according to whether or not one or more untreated high-risk plaques were present, defined as having ≥2 high-risk features (a thin-cap fibroatheroma, plaque burden ≥70{\%}, and/or minimal luminal area ≤4 mm2). Results The high-risk group (those with one or more high-risk lesions) had higher Framingham risk score (7.5 ± 3.4 vs. 6.9 ± 3.3; p = 0.04), more extensive coronary artery disease, and more nonculprit lesion-related cardiovascular events during the 3-year follow-up (hazard ratio: 2.63; 95{\%} confidence interval: 1.62 to 3.66; p < 0.0001). However, demographic factors had poor discrimination in detecting high-risk patients (area under the curve 0.55), and discrimination was only slightly improved when angiographic variables were entered into the model (area under the curve 0.64). Conclusions Clinical and angiographic characteristics had poor predictive accuracy in identifying patients with untreated high-risk plaques related to future adverse events. This finding highlights the potential value of comprehensive 3-vessel imaging assessment (either invasive or noninvasive) to evaluate plaque phenotype for more accurate risk stratification of patients admitted with ACS.",
author = "Bourantas, {Christos V.} and Garcia-Garcia, {Hector M.} and Vasim Farooq and Akiko Maehara and Ke Xu and Philippe Genereux and Roberto Diletti and Takashi Muramatsu and Martin Fahy and Giora Weisz and Stone, {Gregg W.} and Serruys, {Patrick W.}",
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Bourantas, CV, Garcia-Garcia, HM, Farooq, V, Maehara, A, Xu, K, Genereux, P, Diletti, R, Muramatsu, T, Fahy, M, Weisz, G, Stone, GW & Serruys, PW 2013, 'Clinical and angiographic characteristics of patients likely to have vulnerable plaques: Analysis from the PROSPECT study', JACC: Cardiovascular Imaging, vol. 6, no. 12, pp. 1263-1272. https://doi.org/10.1016/j.jcmg.2013.04.015

Clinical and angiographic characteristics of patients likely to have vulnerable plaques : Analysis from the PROSPECT study. / Bourantas, Christos V.; Garcia-Garcia, Hector M.; Farooq, Vasim; Maehara, Akiko; Xu, Ke; Genereux, Philippe; Diletti, Roberto; Muramatsu, Takashi; Fahy, Martin; Weisz, Giora; Stone, Gregg W.; Serruys, Patrick W.

In: JACC: Cardiovascular Imaging, Vol. 6, No. 12, 01.12.2013, p. 1263-1272.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Clinical and angiographic characteristics of patients likely to have vulnerable plaques

T2 - Analysis from the PROSPECT study

AU - Bourantas, Christos V.

AU - Garcia-Garcia, Hector M.

AU - Farooq, Vasim

AU - Maehara, Akiko

AU - Xu, Ke

AU - Genereux, Philippe

AU - Diletti, Roberto

AU - Muramatsu, Takashi

AU - Fahy, Martin

AU - Weisz, Giora

AU - Stone, Gregg W.

AU - Serruys, Patrick W.

PY - 2013/12/1

Y1 - 2013/12/1

N2 - Objectives This study sought to determine the clinical and angiographic variables that would identify patients with high-risk "vulnerable" coronary plaques. Background In the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study, in patients successfully treated for acute coronary syndrome (ACS), plaque composition, plaque burden, and minimal luminal area as detected by 3-vessel radiofrequency intravascular ultrasound (IVUS) imaging were associated with an increased risk of developing future events from untreated atherosclerotic lesions (vulnerable plaques). Whether baseline demographic and angiographic findings can be used to identify patients most likely to have vulnerable coronary plaques has not been examined. Methods On the basis of 3-vessel radiofrequency IVUS imaging, patents in the PROSPECT trial were classified in 2 groups according to whether or not one or more untreated high-risk plaques were present, defined as having ≥2 high-risk features (a thin-cap fibroatheroma, plaque burden ≥70%, and/or minimal luminal area ≤4 mm2). Results The high-risk group (those with one or more high-risk lesions) had higher Framingham risk score (7.5 ± 3.4 vs. 6.9 ± 3.3; p = 0.04), more extensive coronary artery disease, and more nonculprit lesion-related cardiovascular events during the 3-year follow-up (hazard ratio: 2.63; 95% confidence interval: 1.62 to 3.66; p < 0.0001). However, demographic factors had poor discrimination in detecting high-risk patients (area under the curve 0.55), and discrimination was only slightly improved when angiographic variables were entered into the model (area under the curve 0.64). Conclusions Clinical and angiographic characteristics had poor predictive accuracy in identifying patients with untreated high-risk plaques related to future adverse events. This finding highlights the potential value of comprehensive 3-vessel imaging assessment (either invasive or noninvasive) to evaluate plaque phenotype for more accurate risk stratification of patients admitted with ACS.

AB - Objectives This study sought to determine the clinical and angiographic variables that would identify patients with high-risk "vulnerable" coronary plaques. Background In the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study, in patients successfully treated for acute coronary syndrome (ACS), plaque composition, plaque burden, and minimal luminal area as detected by 3-vessel radiofrequency intravascular ultrasound (IVUS) imaging were associated with an increased risk of developing future events from untreated atherosclerotic lesions (vulnerable plaques). Whether baseline demographic and angiographic findings can be used to identify patients most likely to have vulnerable coronary plaques has not been examined. Methods On the basis of 3-vessel radiofrequency IVUS imaging, patents in the PROSPECT trial were classified in 2 groups according to whether or not one or more untreated high-risk plaques were present, defined as having ≥2 high-risk features (a thin-cap fibroatheroma, plaque burden ≥70%, and/or minimal luminal area ≤4 mm2). Results The high-risk group (those with one or more high-risk lesions) had higher Framingham risk score (7.5 ± 3.4 vs. 6.9 ± 3.3; p = 0.04), more extensive coronary artery disease, and more nonculprit lesion-related cardiovascular events during the 3-year follow-up (hazard ratio: 2.63; 95% confidence interval: 1.62 to 3.66; p < 0.0001). However, demographic factors had poor discrimination in detecting high-risk patients (area under the curve 0.55), and discrimination was only slightly improved when angiographic variables were entered into the model (area under the curve 0.64). Conclusions Clinical and angiographic characteristics had poor predictive accuracy in identifying patients with untreated high-risk plaques related to future adverse events. This finding highlights the potential value of comprehensive 3-vessel imaging assessment (either invasive or noninvasive) to evaluate plaque phenotype for more accurate risk stratification of patients admitted with ACS.

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U2 - 10.1016/j.jcmg.2013.04.015

DO - 10.1016/j.jcmg.2013.04.015

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JO - JACC: Cardiovascular Imaging

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