title: Relationship between changes in coronary atherosclerotic plaque burden measured by intravascular ultrasound and cardiovascular disease outcomes: a systematic literature review.
abstract: Objective Evidence from coronary imaging studies suggests an association between increased atherosclerotic plaque burden and cardiovascular disease (CVD) outcomes. A systematic review was performed to evaluate the relationship between coronary atherosclerotic plaque burden changes measured by intravascular ultrasound (IVUS) and CVD outcomes. Research design and methods Rigorous systematic review methodology was used to identify prospective studies of any design assessing the relationship between atherosclerotic plaque volume (percentage or total atheroma volume [PAV or TAV]) changes and CVD outcomes, using multivariable analyses. Main outcome measures CVD outcomes including major adverse cardiac events (MACEs) and major adverse cardiac and cerebrovascular events (MACCEs). Results Literature searches from inception to February 2015 retrieved 6958 records after de-duplication. From these four studies (14 papers) were included. One study reported a significantly lower rate of CVD outcomes associated with a greater reduction in PAV (hazard ratio [HR] 0.26, 95% confidence interval [CI] 0.07-0.83). One study reported that large plaque volume was significantly associated with a greater risk of major adverse cardiac events (MACEs) (HR 1.73, 95% CI: 1.02-2.96). Similarly, a third study reported a significant increase in MACE with an increase in baseline PAV (HR 1.51, 95% CI: 1.06-2.51). Only one potentially inadequately powered Japanese study did not find a statistically significant relationship between PAV changes and MACE. Conclusions The current evidence suggests an independent and statistically significant association between increases in coronary atherosclerotic plaque burden measured by IVUS and greater long-term risk of future CVD outcomes. However, this evidence comes from a limited number of studies which mainly focus on Japanese populations and populations after PCI. Further large prospective studies are required to confirm these findings.
authors.affiliation: a Kleijnen Systematic Reviews Ltd. , York , UK ;
authors.forename: Carol
authors.initials: C
authors.lastname: Forbes
authors.affiliation: b Amgen Inc. , Thousand Oaks , CA , USA ;
authors.forename: Ruben G W
authors.initials: RG
authors.lastname: Quek
authors.affiliation: a Kleijnen Systematic Reviews Ltd. , York , UK ;
authors.forename: Sohan
authors.initials: S
authors.lastname: Deshpande
authors.affiliation: a Kleijnen Systematic Reviews Ltd. , York , UK ;
authors.forename: Gill
authors.initials: G
authors.lastname: Worthy
authors.affiliation: a Kleijnen Systematic Reviews Ltd. , York , UK ;
authors.forename: Janine
authors.initials: J
authors.lastname: Ross
authors.affiliation: b Amgen Inc. , Thousand Oaks , CA , USA ;|c School for Public Health and Primary Care , Maastricht , The Netherlands ;
authors.forename: Jos
authors.initials: J
authors.lastname: Kleijnen
authors.affiliation: b Amgen Inc. , Thousand Oaks , CA , USA ;
authors.forename: Shravanthi R
authors.initials: SR
authors.lastname: Gandra
authors.affiliation: b Amgen Inc. , Thousand Oaks , CA , USA ;
authors.forename: Helina
authors.initials: H
authors.lastname: Kassahun
authors.affiliation: d University of California , Irvine , CA , USA ;
authors.forename: Nathan D
authors.initials: ND
authors.lastname: Wong
authors.affiliation: e South Australian Health and Medical Research Institute, University of Adelaide , Australia.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Nicholls
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology*; D006801:Humans; D058226:Plaque, Atherosclerotic / Q000150:complications* / Q000000981:diagnostic imaging*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018084:Ultrasonography, Interventional
keywords: Atherosclerosis; Atherosclerotic plaque; Cardiovascular diseases; Risk factors; Systematic review