title: Impact of positive and negative lesion site remodeling on clinical outcomes: insights from PROSPECT.
abstract: OBJECTIVE
  This study investigated coronary artery remodeling patterns associated with clinical outcomes.
  
  
  BACKGROUND
  In the prospective, multicenter PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree: An Imaging Study in Patients With Unstable Atherosclerotic Lesions) study, reported predictors of nonculprit lesion (NCL) major adverse cardiac events (MACE) were an intravascular ultrasound (IVUS) minimal lumen area (MLA) ≤4 mm(2), a plaque burden ≥70%, and a IVUS-virtual histology (VH) thin-cap fibroatheroma (TCFA), but not lesion site remodeling.
  
  
  METHODS
  Overall, 697 consecutive patients with an acute coronary syndrome were enrolled and underwent 3-vessel gray-scale and IVUS-VH; 3,223 NCLs were identified by IVUS. The remodeling index (RI) was calculated as the external elastic membrane area at the MLA site divided by the average of the proximal and distal reference external elastic membrane areas. First, one third of the patients were randomly selected to determine RI cutoffs related to NCL MACE (development cohort). Receiver-operating characteristic analysis showed that there were 2 separate cut points that predicted NCL MACE: RI = 0.8789 and RI = 1.0046 (area under the curve = 0.663). These cut points were used to define negative remodeling as an RI <0.88, intermediate remodeling as an RI of 0.88 to 1.00, and positive remodeling as an RI >1.00. Second, we used the remaining two-thirds of patients to validate these cut points with respect to lesion morphology and clinical outcomes (validation cohort).
  
  
  RESULTS
  Kaplan-Meier curve analysis in the validation cohort showed that NCL MACE occurred more frequent (and equally) in negative and positive remodeling lesions compared with intermediate remodeling lesions. In this cohort, negative remodeling lesions had the smallest MLA, positive remodeling lesions had the largest plaque burden, and VH TCFA, especially VH TCFA with multiple necrotic cores, was most common in negatively remodeling lesions.
  
  
  CONCLUSIONS
  The present study showed the novel concept that positive and negative lesion site remodeling was associated with unanticipated NCL MACE in the PROSPECT study. (
  
  
  CONCLUSIONS
  An Imaging Study in Patients With Unstable Atherosclerotic Lesions [PROSPECT]; NCT00180466).
authors.affiliation: Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York.
authors.forename: Shinji
authors.initials: S
authors.lastname: Inaba
authors.affiliation: Cardiovascular Research Foundation, New York, New York.
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.affiliation: North Ohio Heart Center/Elyria Memorial Hospital Regional Medical Center, Elyria, Ohio.
authors.forename: Naim Z
authors.initials: NZ
authors.lastname: Farhat
authors.affiliation: Clinique Pasteur, Toulouse, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Fajadet
authors.affiliation: Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Dudek
authors.affiliation: Policlinico Universitario S. Orsola-Malpighi, Bologna, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Marzocchi
authors.affiliation: Abbott Vascular, Santa Clara, California.
authors.forename: Barry
authors.initials: B
authors.lastname: Templin
authors.affiliation: Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York.
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
authors.affiliation: Cardiovascular Research Foundation, New York, New York.
authors.forename: Ke
authors.initials: K
authors.lastname: Xu
authors.affiliation: Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.
authors.forename: Bernard
authors.initials: B
authors.lastname: de Bruyne
authors.affiliation: Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.affiliation: Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York.
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.affiliation: Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York. Electronic address: amaehara@crf.org.
authors.forename: Akiko
authors.initials: A
authors.lastname: Maehara
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D003331:Coronary Vessels / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D014943:Global Health; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D018084:Ultrasonography, Interventional
keywords: CSA; DC; EEM; FF; FT; IVUS; MLA; NC; NCL MACE; RI; ROC; TCFA; ThCFA; VH; cardiovascular events; cross-sectional; dense calcium; external elastic membrane; fibrofatty; fibrotic; intravascular ultrasound; minimal lumen area; necrotic core; nonculprit lesion major adverse cardiac event(s); receiver-operating characteristic; remodeling; remodeling index; thick-cap fibroatheroma; thin-cap fibroatheroma; virtual histology