title: Dynamic nature of nonculprit coronary artery lesion morphology in STEMI: a serial IVUS analysis from the HORIZONS-AMI trial.
abstract: OBJECTIVE
  The authors sought to report the temporal stability of an untreated, nonculprit lesion phenotype in patients presenting with ST-segment elevation myocardial infarction (STEMI).
  
  
  BACKGROUND
  The temporal stability of the untreated, nonculprit lesion phenotype has been studied using intravascular ultrasound-virtual histology (IVUS) in patients with stable ischemic heart disease, but not in STEMI patients.
  
  
  METHODS
  As part of a formal substudy of the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) trial, baseline and 13-month follow-up IVUS was performed in 99 untreated nonculprit lesions in 63 STEMI patients. Lesions were classified as pathological intimal thickening (PIT), IVUS-derived thin-cap fibroatheroma (TCFA), thick-cap fibroatheroma (ThCFA), fibrotic plaque, or fibrocalcific plaque.
  
  
  RESULTS
  The frequency of TCFA increased from 41% at baseline to 54% at follow-up, whereas ThCFAs decreased from 41% to 34% and PIT decreased from 16% to 8%. Among the 41 lesions classified at baseline as TCFA, at follow-up, 32 (78%) were still classified as TCFA, whereas 9 (22%) were classified as ThCFAs or fibrotic plaques. An additional 21 lesions at follow-up were newly classified as TCFA, developing from either PIT or ThCFA. TCFA at baseline that evolved into non-TCFAs trended toward a more distal location than TCFA that did not change (p = 0.12). In lesions classified as TCFA, the minimum lumen area (MLA) decreased from 8.1 (interquartile range [IQR]: 7.4 to 8.8) mm(2) at baseline to 7.8 (IQR: 7.2 to 8.4) mm(2) at follow-up, p < 0.05; this was associated with an increase in percent necrotic core at the MLA site (14% [IQR: 12 to 16] to 19% [IQR: 17 to 22], p < 0.0001) and over the entire length of the lesion (14% [IQR: 12 to 16] to 18% [IQR: 17 to 20], p < 0.0001).
  
  
  CONCLUSIONS
  Untreated nonculprit lesions in STEMI patients frequently have TCFA morphology that does not change during 13-month follow-up and is accompanied by a decrease in MLA and an increase in necrotic core. (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction [HORIZONS-AMI]; NCT00433966).
authors: Columbia University Medical Center/The Cardiovascular Research Foundation, New York, New York 10022, USA.
authors: Zhijing
authors: Z
authors: Zhao
authors: Bernhard
authors: B
authors: Witzenbichler
authors: Gary S
authors: GS
authors: Mintz
authors: Markus
authors: M
authors: Jaster
authors: So-Yeon
authors: SY
authors: Choi
authors: Xiaofan
authors: X
authors: Wu
authors: Yong
authors: Y
authors: He
authors: M Pauliina
authors: MP
authors: Margolis
authors: Ovidiu
authors: O
authors: Dressler
authors: Ecaterina
authors: E
authors: Cristea
authors: Helen
authors: H
authors: Parise
authors: Roxana
authors: R
authors: Mehran
authors: Gregg W
authors: GW
authors: Stone
authors: Akiko
authors: A
authors: Maehara
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D005355:Fibrosis; D006801:Humans; D016018:Least-Squares Analysis; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology / Q000628:therapy; D009204:Myocardial Revascularization / Q000295:instrumentation; D009336:Necrosis; D058226:Plaque, Atherosclerotic; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011237:Predictive Value of Tests; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors