title: Culprit lesion remodelling and long-term prognosis in patients with acute coronary syndrome: an intravascular ultrasound study.
abstract: OBJECTIVE
  Positive arterial remodelling is recognized as one of the morphological characteristics of the vulnerable plaque. Limited data are available on a long-term outcome of acute coronary syndrome (ACS) patients with culprit lesion positive arterial remodelling (PR). The aim of this study was to investigate the long-term impact of culprit lesion PR in patients with ACS.
  
  
  RESULTS
  In 134 patients with ACS, intravascular ultrasound (IVUS) was performed to assess target lesion remodelling before percutaneous coronary intervention. PR was defined as the ratio of the external elastic membrane cross-sectional area at the target lesion to that of at the proximal reference of >1.05, and intermediate or negative remodelling (IR/NR) was defined as that of ≤1.05. Major adverse cardiac event (MACE) was defined as a composite of death, ACS, and target lesion revascularization. During the follow-up (median 5.8 years), MACE-free survival was significantly lower in the PR group than that in the IR/NR group (log-rank, P = 0.005). Survival and ACS-free survival were also significantly lower in the PR group than that in the IR/NR group (log-rank, both P = 0.04). By multivariable Cox regression analysis, PR (hazard ratio = 2.4, P = 0.02) and diabetes (hazard ratio = 1.9, P = 0.03) were independent predictors of MACE.
  
  
  CONCLUSIONS
  Culprit lesion PR was associated with a poor long-term prognosis in patients with ACS. PR may be a marker of vulnerable patients.
authors.affiliation: Division of Cardiology, Bell Land General Hospital, Sakai, Japan. hokura@fides.dti.ne.jp
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Okura
authors.forename: Toru
authors.initials: T
authors.lastname: Kataoka
authors.forename: Nobuya
authors.initials: N
authors.lastname: Matsushita
authors.forename: Kenji
authors.initials: K
authors.lastname: Shimeno
authors.forename: Minoru
authors.initials: M
authors.lastname: Yoshiyama
authors.forename: Junichi
authors.initials: J
authors.lastname: Yoshikawa
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Yoshida
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000628:therapy*; D000368:Aged; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015607:Stents; D015996:Survival Rate; D018084:Ultrasonography, Interventional
keywords: Acute coronary syndrome; Intravascular ultrasound, Remodelling; Prognosis; Vulnerable plaque