Prediction of progression of coronary artery disease and clinical outcomes using vascular profiling of endothelial shear stress and arterial plaque characteristics: the PREDICTION Study.
BACKGROUND
Atherosclerotic plaques progress in a highly individual manner. The purposes of the Prediction of Progression of Coronary Artery Disease and Clinical Outcome Using Vascular Profiling of Shear Stress and Wall Morphology (PREDICTION) Study were to determine the role of local hemodynamic and vascular characteristics in coronary plaque progression and to relate plaque changes to clinical events.


RESULTS
Vascular profiling, using coronary angiography and intravascular ultrasound, was used to reconstruct each artery and calculate endothelial shear stress and plaque/remodeling characteristics in vivo. Three-vessel vascular profiling (2.7 arteries per patient) was performed at baseline in 506 patients with an acute coronary syndrome treated with a percutaneous coronary intervention and in a subset of 374 (74%) consecutive patients 6 to 10 months later to assess plaque natural history. Each reconstructed artery was divided into sequential 3-mm segments for serial analysis. One-year clinical follow-up was completed in 99.2%. Symptomatic clinical events were infrequent: only 1 (0.2%) cardiac death; 4 (0.8%) patients with new acute coronary syndrome in nonstented segments; and 15 (3.0%) patients hospitalized for stable angina. Increase in plaque area (primary end point) was predicted by baseline large plaque burden; decrease in lumen area (secondary end point) was independently predicted by baseline large plaque burden and low endothelial shear stress. Large plaque size and low endothelial shear stress independently predicted the exploratory end points of increased plaque burden and worsening of clinically relevant luminal obstructions treated with a percutaneous coronary intervention at follow-up. The combination of independent baseline predictors had a 41% positive and 92% negative predictive value to predict progression of an obstruction treated with a percutaneous coronary intervention.


CONCLUSIONS
Large plaque burden and low local endothelial shear stress provide independent and additive prediction to identify plaques that develop progressive enlargement and lumen narrowing.


BACKGROUND
URL: http:www.//clinicaltrials.gov. Unique Identifier: NCT01316159.
Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA. pstone@partners.org
Peter H
PH
Stone
Shigeru
S
Saito
Saeko
S
Takahashi
Yasuhiro
Y
Makita
Shigeru
S
Nakamura
Tomohiro
T
Kawasaki
Akihiko
A
Takahashi
Takaaki
T
Katsuki
Sunao
S
Nakamura
Atsuo
A
Namiki
Atsushi
A
Hirohata
Toshiyuki
T
Matsumura
Seiji
S
Yamazaki
Hiroyoshi
H
Yokoi
Shinji
S
Tanaka
Satoru
S
Otsuji
Fuminobu
F
Yoshimachi
Junko
J
Honye
Dawn
D
Harwood
Martha
M
Reitman
Ahmet U
AU
Coskun
Michail I
MI
Papafaklis
Charles L
CL
Feldman
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology; D018450:Disease Progression; D004730:Endothelium, Vascular / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000473:pathology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D013314:Stress, Mechanical; D016896:Treatment Outcome; D014463:Ultrasonography