title: In vivo detection of high-risk coronary plaques by radiofrequency intravascular ultrasound and cardiovascular outcome: results of the ATHEROREMO-IVUS study.
abstract: OBJECTIVE
  Acute coronary syndromes (ACS) are mostly caused by plaque rupture. This study aims to investigate the prognostic value of in vivo detection of high-risk coronary plaques by intravascular ultrasound (IVUS) in patients undergoing coronary angiography.
  
  
  RESULTS
  Between November 2008 and January 2011, IVUS of a non-culprit coronary artery was performed in 581 patients who underwent coronary angiography for ACS (n = 318) or stable angina (n = 263). Primary endpoint was major adverse cardiac events (MACEs) defined as mortality, ACS, or unplanned coronary revascularization. Culprit lesion-related events were not counted. Cumulative Kaplan-Meier incidence of 1-year MACE was 7.8%. The presence of IVUS virtual histology-derived thin-cap fibroatheroma (TCFA) lesions (present 10.8% vs. absent 5.6%; adjusted HR: 1.98, 95% CI: 1.09-3.60; P = 0.026) and lesions with a plaque burden of ≥70% (present 16.2% vs. absent 5.5%; adjusted HR: 2.90, 95% CI: 1.60-5.25; P < 0.001) were independently associated with a higher MACE rate. Thin-cap fibroatheroma lesions were also independently associated with the composite of death or ACS only (present 7.5% vs. absent 3.0%; adjusted HR: 2.51, 95% CI: 1.15-5.49; P = 0.021). Thin-cap fibroatheroma lesions with a plaque burden of ≥70% were associated with a higher MACE rate within (P = 0.011) and after (P < 0.001) 6 months of follow-up, while smaller TCFA lesions were only associated with a higher MACE rate after 6 months (P = 0.033).
  
  
  CONCLUSIONS
  In patients undergoing coronary angiography, the presence of IVUS virtual histology-derived TCFA lesions in a non-culprit coronary artery is strongly and independently predictive for the occurrence of MACE within 1 year, particularly of death and ACS. Thin-cap fibroatheroma lesions with a large plaque burden carry higher risk than small TCFA lesions, especially on the short term.
authors.affiliation: Department of Cardiology, Erasmus MC, Rotterdam, Room Bd-381, PO Box 2040, 3000, the Netherlands.
authors.forename: Jin M
authors.initials: JM
authors.lastname: Cheng
authors.forename: Hector M
authors.initials: HM
authors.lastname: Garcia-Garcia
authors.forename: Sanneke P M
authors.initials: SP
authors.lastname: de Boer
authors.forename: Isabella
authors.initials: I
authors.lastname: Kardys
authors.forename: Jung Ho
authors.initials: JH
authors.lastname: Heo
authors.forename: K Martijn
authors.initials: KM
authors.lastname: Akkerhuis
authors.forename: Rohit M
authors.initials: RM
authors.lastname: Oemrawsingh
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: Jurgen
authors.initials: J
authors.lastname: Ligthart
authors.forename: Karen T
authors.initials: KT
authors.lastname: Witberg
authors.forename: Evelyn
authors.initials: E
authors.lastname: Regar
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Robert-Jan
authors.initials: RJ
authors.lastname: van Geuns
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
mesh_terms: D060050:Angina, Stable / Q000000981:diagnostic imaging / Q000209:etiology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D012086:Reoperation; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: Atherosclerosis; Intravascular ultrasound; Natural history; Prognosis; Thin-cap fibroatheroma; Virtual histology