Predictors of Plaque Rupture Within Nonculprit Fibroatheromas in Patients With Acute Coronary Syndromes: The PROSPECT Study.
OBJECTIVE
The study sought to examine the relative importance of lesion location versus vessel area and plaque burden in predicting plaque rupture within nonculprit fibroatheromas (FAs) in patients with acute coronary syndromes.


BACKGROUND
Previous studies have demonstrated that plaque rupture is associated with larger vessel area and greater plaque burden clustering in the proximal segments of coronary arteries.


METHODS
In the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study 3-vessel grayscale and radiofrequency-intravascular ultrasound was performed after successful percutaneous coronary intervention in 697 patients with acute coronary syndromes. Untreated nonculprit lesion FAs were classified as proximal (<20 mm), mid (20 to 40 mm), and distal (>40 mm) according to the distance from the ostium to the maximum necrotic core site.


RESULTS
Overall, 74 ruptured FAs and 2,396 nonruptured FAs were identified in nonculprit vessels. The majority of FAs (73.6%) were located within 40 mm of the ostium, and the vessel area and plaque burden progressively decreased from proximal to distal FA location (both p < 0.001). In a multivariate logistic regression model, independent predictors for plaque rupture included the distance from the ostium to the maximum necrotic core site per millimeter (odds ratio [OR]: 0.86; 95% confidence interval [CI]: 0.76 to 0.98; p = 0.02), plaque burden per 10% (OR: 2.05; 95% CI: 1.63 to 2.58; p < 0.0001), vessel area per mm(2) (OR: 1.14; 95% CI: 1.11 to 1.17; p < 0.0001), calcium (OR: 0.09; 95% CI: 0.05 to 0.18; p < 0.0001), and right coronary artery location (OR: 2.16; 95% CI: 1.25 to 3.27; p = 0.006). By receiver-operating characteristic analysis, vessel area correlated with plaque rupture stronger than either plaque burden (p < 0.001) or location (p < 0.001).


CONCLUSIONS
Large vessel area, plaque burden, proximal location, right coronary artery location, and lack of calcium were associated with FA plaque rupture. The present study suggests that among these variables, vessel area may be the strongest predictor of plaque rupture among non-left main coronary arteries. (


CONCLUSIONS
An Imaging Study in Patients With Unstable Atherosclerotic Lesions [PROSPECT]; NCT00180466).
New York-Presbyterian/Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York; Peking University First Hospital, Beijing, China.
Bo
B
Zheng
Cardiovascular Research Foundation, New York, New York.
Gary S
GS
Mintz
Vanderbilt University School of Medicine, Nashville, Tennessee.
John A
JA
McPherson
Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.
Bernard
B
De Bruyne
North Ohio Heart Center/Elyria Memorial Hospital Regional Medical Center, Elyria, Ohio.
Naim Z
NZ
Farhat
University of Texas Southwestern Medical Center, Dallas, Texas.
Steven P
SP
Marso
Erasmus Medical Center, Rotterdam, the Netherlands.
Patrick W
PW
Serruys
New York-Presbyterian/Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York.
Gregg W
GW
Stone
New York-Presbyterian/Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York. Electronic address: amaehara@crf.org.
Akiko
A
Maehara
D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D000368:Aged; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D005355:Fibrosis; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D012307:Risk Factors; D012422:Rupture, Spontaneous; D018084:Ultrasonography, Interventional
fibroatheroma; intravascular ultrasound; plaque rupture