title: Intravascular ultrasound-derived measures of coronary atherosclerotic plaque burden and clinical outcome.
abstract: OBJECTIVE
  The aim of this study was to investigate the relationship between intravascular ultrasound (IVUS)-derived measures of atherosclerosis and cardiovascular outcomes.
  
  
  BACKGROUND
  IVUS has been used in clinical trials to evaluate the effect of medical therapies on coronary atheroma progression.
  
  
  METHODS
  Coronary plaque progression was evaluated in 4,137 patients in 6 clinical trials that used serial IVUS. The relationship between baseline and change in percent atheroma volume (PAV) and total atheroma volume with incident major adverse cardiovascular events (MACE) was investigated.
  
  
  RESULTS
  PAV increased by 0.3% (p < 0.001), and 19.9% of subjects experienced MACE (0.9% death, 1.8% myocardial infarction, 18.9% coronary revascularization). Greater baseline PAVs were observed in patients who experienced myocardial infarctions (42.2 +/- 9.6% vs. 38.6 +/- 9.1%, p = 0.001), coronary revascularization (41.2 +/- 9.3% vs. 38.1 +/- 9.0%, p < 0.001), or MACE (41.3 +/- 9.2% vs. 38.0 +/- 9.0%, p < 0.001). Each standard deviation increase in PAV was associated with a 1.32-fold (95% confidence interval: 1.22 to 1.42; p < 0.001) greater likelihood of experiencing a MACE. During follow-up (21.1 +/- 3.7 months), greater increases in PAV, but not total atheroma volume, were observed in subjects who experienced MACE compared with those who did not (0.95 +/- 0.19% vs. 0.46 +/- 0.16%, p < 0.001). Each standard deviation increase in PAV was associated with a 1.20-fold (95% confidence interval: 1.10 to 1.31; p < 0.001) greater risk for MACE. Multivariate analysis revealed that factors associated with MACE included baseline PAV (p < 0.0001), change in PAV (p = 0.002), smoking (p = 0.0002) and hypertension (p = 0.01).
  
  
  CONCLUSIONS
  A direct relationship was observed between the burden of coronary atherosclerosis, its progression, and adverse cardiovascular events. The relationship between disease progression and outcomes largely reflected the need for coronary revascularization. These data support the use of atherosclerosis imaging with IVUS in the evaluation of novel antiatherosclerotic therapies.
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA. nichols1@ccf.org
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Nicholls
authors.forename: Amy
authors.initials: A
authors.lastname: Hsu
authors.forename: Kathy
authors.initials: K
authors.lastname: Wolski
authors.forename: Bo
authors.initials: B
authors.lastname: Hu
authors.forename: Ozgur
authors.initials: O
authors.lastname: Bayturan
authors.forename: Andrea
authors.initials: A
authors.lastname: Lavoie
authors.forename: Kiyoko
authors.initials: K
authors.lastname: Uno
authors.forename: E Murat
authors.initials: EM
authors.lastname: Tuzcu
authors.forename: Steven E
authors.initials: SE
authors.lastname: Nissen
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D015331:Cohort Studies; D016001:Confidence Intervals; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D009204:Myocardial Revascularization / Q000009:adverse effects / Q000379:methods; D011336:Probability; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional