Impact of plaque characteristics analyzed by intravascular ultrasound on long-term clinical outcomes.
Limited data are available on long-term outcomes for vulnerable plaque analyzed by intravascular ultrasound (IVUS). The aim of this study was to investigate long-term clinical outcomes in 183 patients (79 with stable angina pectoris and 104 with acute coronary syndromes) who underwent preintervention 3-vessel IVUS and single-vessel stent implantation. Critical events, defined as any cause of death and acute coronary syndromes during follow-up, were evaluated. Plaque characteristics were analyzed in the target vessel and nontarget vessels. Vulnerable plaques were arbitrarily defined as plaques with rupture, lipid core, dissection, or thrombus. The mean follow-up period was 50 +/- 20 months. Critical events developed in 12 patients (7%; 6 acute coronary syndromes, 6 deaths). The critical event-free rate was not different according to the presence of vulnerable plaques in the target lesion (95% vs 95%, p = 0.86). However, in the nontarget vessels, the long-term critical event-free rate was significantly lower in patients with vulnerable plaques (88% vs 96%, p = 0.04). On multivariate Cox regression analysis, the multiplicity of vulnerable plaques in the nontarget vessels (hazard ratio 2.2, 95% confidence interval 1.4 to 3.4, p = 0.001) was the only independent predictor of long-term critical events. Acute coronary syndromes (odds ratio 5.4, 95% confidence interval 2.1 to 14.3, p = 0.001) and diabetes mellitus (odds ratio 5.2, 95% confidence interval 1.9 to 13.8, p = 0.001) were significantly associated with the multiplicity of vulnerable plaques. In conclusion, the multiplicity of vulnerable plaques in nontarget vessels was the most important predictor of future critical cardiac events in this 3-vessel IVUS study.
Kim
Sung-Hwan
SH
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Hong
Myeong-Ki
MK
Park
Duk-Woo
DW
Lee
Seung-Whan
SW
Kim
Young-Hak
YH
Lee
Cheol Whan
CW
Kim
Jae-Joong
JJ
Park
Seong-Wook
SW
Park
Seung-Jung
SJ
D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D000367:Age Factors; D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary / Q000379:methods* / Q000401:mortality; D015331:Cohort Studies; D016001:Confidence Intervals; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012737:Sex Factors; D015607:Stents; D016019:Survival Analysis; D018084:Ultrasonography, Interventional