title: Clinical and angiographic characteristics of patients likely to have vulnerable plaques: analysis from the PROSPECT study.
abstract: OBJECTIVE
  This study sought to determine the clinical and angiographic variables that would identify patients with high-risk "vulnerable" coronary plaques.
  
  
  BACKGROUND
  In the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study, in patients successfully treated for acute coronary syndrome (ACS), plaque composition, plaque burden, and minimal luminal area as detected by 3-vessel radiofrequency intravascular ultrasound (IVUS) imaging were associated with an increased risk of developing future events from untreated atherosclerotic lesions (vulnerable plaques). Whether baseline demographic and angiographic findings can be used to identify patients most likely to have vulnerable coronary plaques has not been examined.
  
  
  METHODS
  On the basis of 3-vessel radiofrequency IVUS imaging, patents in the PROSPECT trial were classified in 2 groups according to whether or not one or more untreated high-risk plaques were present, defined as having ≥2 high-risk features (a thin-cap fibroatheroma, plaque burden ≥70%, and/or minimal luminal area ≤4 mm(2)).
  
  
  RESULTS
  The high-risk group (those with one or more high-risk lesions) had higher Framingham risk score (7.5 ± 3.4 vs. 6.9 ± 3.3; p = 0.04), more extensive coronary artery disease, and more nonculprit lesion-related cardiovascular events during the 3-year follow-up (hazard ratio: 2.63; 95% confidence interval: 1.62 to 3.66; p < 0.0001). However, demographic factors had poor discrimination in detecting high-risk patients (area under the curve 0.55), and discrimination was only slightly improved when angiographic variables were entered into the model (area under the curve 0.64).
  
  
  CONCLUSIONS
  Clinical and angiographic characteristics had poor predictive accuracy in identifying patients with untreated high-risk plaques related to future adverse events. This finding highlights the potential value of comprehensive 3-vessel imaging assessment (either invasive or noninvasive) to evaluate plaque phenotype for more accurate risk stratification of patients admitted with ACS.
authors.affiliation: ThoraxCenter, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Christos V
authors.initials: CV
authors.lastname: Bourantas
authors.affiliation: ThoraxCenter, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Hector M
authors.initials: HM
authors.lastname: Garcia-Garcia
authors.affiliation: ThoraxCenter, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Vasim
authors.initials: V
authors.lastname: Farooq
authors.affiliation: Department of Cardiology, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York.
authors.forename: Akiko
authors.initials: A
authors.lastname: Maehara
authors.affiliation: Department of Cardiology, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York.
authors.forename: Ke
authors.initials: K
authors.lastname: Xu
authors.affiliation: Department of Cardiology, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York.
authors.forename: Philippe
authors.initials: P
authors.lastname: Généreux
authors.affiliation: ThoraxCenter, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Roberto
authors.initials: R
authors.lastname: Diletti
authors.affiliation: ThoraxCenter, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Takashi
authors.initials: T
authors.lastname: Muramatsu
authors.affiliation: Department of Cardiology, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York.
authors.forename: Martin
authors.initials: M
authors.lastname: Fahy
authors.affiliation: Department of Cardiology, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York.
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
authors.affiliation: Department of Cardiology, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York.
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.affiliation: ThoraxCenter, Erasmus Medical Center, Rotterdam, the Netherlands. Electronic address: p.w.j.c.serruys@erasmusmc.nl.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000209:etiology; D000368:Aged; D019540:Area Under Curve; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D005355:Fibrosis; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D012422:Rupture, Spontaneous; D012720:Severity of Illness Index
keywords: ACS; C-reactive protein; CRP; EEM; IVUS; MACE; MLA; QCA; TCFA; VH; acute coronary syndrome; cardiovascular events; coronary angiography; external elastic membrane; intravascular ultrasound; major adverse cardiac events; minimum lumen area; quantitative coronary angiography; thin-cap fibroatheroma; virtual histology