title: Association between IVUS findings and adverse outcomes in patients with coronary artery disease: the VIVA (VH-IVUS in Vulnerable Atherosclerosis) Study.
abstract: OBJECTIVE
  The purpose of this study was to determine whether thin-capped fibroatheromata (TCFA) identified by virtual histology intravascular ultrasound (VH-IVUS) are associated with major adverse cardiac events (MACE) on individual plaque or whole patient analysis.
  
  
  BACKGROUND
  Post-mortem studies have identified TCFA as the substrate for most myocardial infarctions. However, little is known about the natural history of individual TCFA and their link with MACE. VH-IVUS provides a method of identifying plaques in vivo that are similar (although not identical) to histologically defined TCFA, and has been validated in human atherectomy and post-mortem studies.
  
  
  METHODS
  One hundred seventy patients with stable angina or troponin-positive acute coronary syndrome referred for percutaneous coronary intervention (PCI) were prospectively enrolled and underwent 3-vessel VH-IVUS pre-PCI and also post-PCI in the culprit vessel. MACE consisted of death, myocardial infarction, or unplanned revascularization.
  
  
  RESULTS
  In all, 30,372 mm of VH-IVUS were analyzed. Eighteen MACE occurred in 16 patients over a median follow-up of 625 days (interquartile range: 463 to 990 days); 1,096 plaques were classified, and 19 lesions resulted in MACE (13 nonculprit lesions and 6 culprit lesions). Nonculprit lesion factors associated with nonrestenotic MACE included VHTCFA (hazard ratio [HR]: 7.53, p = 0.038) and plaque burden >70% (HR: 8.13, p = 0.011). VHTCFA (HR: 8.16, p = 0.007), plaque burden >70% (HR: 7.48, p < 0.001), and minimum luminal area <4 mm(2) (HR: 2.91, p = 0.036) were associated with total MACE. On patient-based analysis, the only factor associated with nonrestenotic MACE was 3-vessel noncalcified VHTCFA (HR: 1.79, p = 0.004).
  
  
  CONCLUSIONS
  VH-IVUS TCFA was associated with nonrestenotic and total MACE on individual plaque analysis, and noncalcified VHTCFA was associated with nonrestenotic and total MACE on whole-patient analysis, demonstrating that VH-IVUS can identify plaques at increased risk of subsequent events. The preservation of the association between VHTCFA and MACE despite various analyses emphasizes its biological importance.
authors.affiliation: Division of Cardiovascular Medicine, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Calvert
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Obaid
authors.forename: Michael
authors.initials: M
authors.lastname: O'Sullivan
authors.forename: Leonard M
authors.initials: LM
authors.lastname: Shapiro
authors.forename: Duncan
authors.initials: D
authors.lastname: McNab
authors.forename: Cameron G
authors.initials: CG
authors.lastname: Densem
authors.forename: Peter M
authors.initials: PM
authors.lastname: Schofield
authors.forename: Denise
authors.initials: D
authors.lastname: Braganza
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Clarke
authors.forename: Kausik K
authors.initials: KK
authors.lastname: Ray
authors.forename: Nick E J
authors.initials: NE
authors.lastname: West
authors.forename: Martin R
authors.initials: MR
authors.lastname: Bennett
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D000787:Angina Pectoris / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D004739:England; D006801:Humans; D053208:Kaplan-Meier Estimate; D009203:Myocardial Infarction; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional