title: Adverse cardiovascular events arising from atherosclerotic lesions with and without angiographic disease progression.
abstract: OBJECTIVE
  The aim of this study was to use angiography and grayscale and intravascular ultrasound-virtual histology to assess coronary lesions that caused events during a median follow-up period of 3.4 years.
  
  
  BACKGROUND
  Vulnerable plaque-related events are assumed to be the result of substantial progression of insignificant lesions.
  
  
  METHODS
  In the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study, 697 patients with acute coronary syndromes underwent treatment of all culprit lesions followed by 3-vessel imaging to assess the natural history of culprit and untreated nonculprit (NC) lesions. Future adverse cardiovascular events adjudicated to NC lesions were divided into those with versus without substantial lesion progression (SLP) (≥ 20% angiographic diameter stenosis increase).
  
  
  RESULTS
  NC lesion events occurred in 72 patients, 44 (61%) with and 28 (39%) without SLP. Myocardial infarctions (n = 6) occurred only in patients with SLP. Conversely, patients without SLP presented only with unstable or increasing angina requiring rehospitalization. Lesions with versus without SLP occurred later (median time to event 401 vs. 223 days, p = 0.07); were less severe at baseline (median diameter stenosis 26.4% vs. 53.8%, p < 0.0001) but more severe at the time of the event (mean diameter stenosis 73.8% vs. 56%, p < 0.0001); and had comparable baseline median plaque burden (68.7% vs. 70.1%, p = 0.17), minimum luminal area (3.7 vs. 4.0 mm(2), p = 0.60), and intravascular ultrasound-virtual histology phenotype (83.3% vs. 90.9%, p = 0.68; classified as fibroatheromas at baseline).
  
  
  CONCLUSIONS
  NC lesions responsible for future cardiovascular events showed angiographic increase during 3.4 years of follow-up, whereas SLP underlay many but not all of them. NC events due to lesions with SLP were angiographically less severe and presented with a delayed time course but were otherwise indistinguishable from NC events that were not associated with SLP.
authors.affiliation: Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York 10022, USA.
authors.forename: Elias A
authors.initials: EA
authors.lastname: Sanidas
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.forename: Akiko
authors.initials: A
authors.lastname: Maehara
authors.forename: Ecaterina
authors.initials: E
authors.lastname: Cristea
authors.forename: Bertil
authors.initials: B
authors.lastname: Wennerblom
authors.forename: Andres
authors.initials: A
authors.lastname: Iñiguez
authors.forename: Jean
authors.initials: J
authors.lastname: Fajadet
authors.forename: Martin
authors.initials: M
authors.lastname: Fahy
authors.forename: Ovidiu
authors.initials: O
authors.lastname: Dressler
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
authors.forename: Barry
authors.initials: B
authors.lastname: Templin
authors.forename: Zhen
authors.initials: Z
authors.lastname: Zhang
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Lansky
authors.forename: Bernard
authors.initials: B
authors.lastname: de Bruyne
authors.forename: Patrick
authors.initials: P
authors.lastname: Serruys
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D005060:Europe / Q000453:epidemiology; D005260:Female; D005355:Fibrosis; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality; D009336:Necrosis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014481:United States / Q000453:epidemiology; D061205:Vascular Calcification / Q000000981:diagnostic imaging