Morphology (PREDICTION) Study were to determine the role of local hemodynamic and vascular characteristics in coronary plaque progression and to relate plaque changes to clinical events. Methods and Results-Vascular profiling, using coronary angiography and intravascular ultrasound, was used to reconstruct each artery and calculate endothelial shear stress and plaque/remodeling characteristics in vivo. Three-vessel vascular profiling (2.7 arteries per patient) was performed at baseline in 506 patients with an acute coronary syndrome treated with a percutaneous coronary intervention and in a subset of 374 (74%) consecutive patients 6 to 10 months later to assess plaque natural history. Each reconstructed artery was divided into sequential 3-mm segments for serial analysis. One-year clinical follow-up was completed in 99.2%. Symptomatic clinical events were infrequent: only 1 (0.2%) cardiac death; 4 (0.8%) patients with new acute coronary syndrome in nonstented segments; and 15 (3.0%) patients hospitalized for stable angina. Increase in plaque area (primary end point) was predicted by baseline large plaque burden; decrease in lumen area (secondary end point) was independently predicted by baseline large plaque burden and low endothelial shear stress. Large plaque size and low endothelial shear stress independently predicted the exploratory end points of increased plaque burden and worsening of clinically relevant luminal obstructions treated with a percutaneous coronary intervention at follow-up. The combination of independent baseline predictors had a 41% positive and 92% negative predictive value to predict progression of an obstruction treated with a percutaneous coronary intervention. Conclusions-Large plaque burden and low local endothelial shear stress provide independent and additive prediction to identify plaques that develop progressive enlargement and lumen narrowing. Clinical Trial Registration-URL: http:www.//clinicaltrials.gov. Unique Identifier: NCT01316159. (Circulation. 2012;126:172-181.) Key Words: atherosclerosis Ⅲ endothelium Ⅲ natural history Ⅲ shear stress A therosclerosis is a systemic disease with focal and eccentric manifestations. 1 In a patient with coronary artery disease (CAD) and systemic risk factors, each coronary lesion progresses, regresses, or remains quiescent in an independent manner, 2 indicating that local vascular factors must be a major determinant responsible for the behavior of individual plaques. Editorial see p 161 Clinical Perspective on p 181The vascular endothelium is in a unique and pivotal position to respond to the extremely dynamic forces acting on the vessel wall because of the complex 3-dimensional (3D) Received January 27, 2012; accepted May 16, 2012. Identification of an early coronary atherosclerotic plaque likely to acquire high-risk characteristics and precipitate a new coronary event may allow for development of preemptive strategies to avert adverse events. The recent Providing Regional Observations to Study Predictors of Events in the Coronary Tree (PR...

Background. Histological examination of the effects of balloon angioplasty have been described from in vitro experiments and a limited number of pathologic specimens. Intravascular ultrasound imaging permits real time cross-sectional observation of the effect of balloon dilation on the atherosclerotic plaque in vivo.Methods and Resuls. The morphological effects of coronary angioplasty were visualized at 66 lesions in 47 patients immediately after balloon dilatation with an intravascular ultrasound imaging catheter. Cross-

Six months of DAPT was not inferior to 18 months of DAPT following implantation of a DES with a biodegradable abluminal coating. However, this result needs to be interpreted with caution given the open-label design and wide noninferiority margin of the present study. (Nobori Dual Antiplatelet Therapy as Appropriate Duration [NIPPON]; NCT01514227).

Circ J 2009; 73: 718 -725 here have been many reports that intensive lowering of low-density lipoprotein-cholesterol (LDL-C) with 3-hydroxy-3-methylglutaryl-coenzyme A (HMGCoA) reductase inhibitors (statins) is effective in preventing cardiovascular events. [1][2][3] Although the mechanism by which statins confer cardiovascular benefit is not precisely understood, regression of coronary plaque volume and reduction of plaque vulnerability are presumed to play important roles. Angioscopic observations have shown that the presence of yellow plaque is associated with unstable symptoms, which suggests that as plaques become more yellow in appearance, they also become more prone to rupture. [4][5][6] Editorial p 628Angioscopy is used to assess plaque vulnerability on the basis of its color and the presence of thrombi. 7,8 Angioscopy gives a full-color, 3-dimensional perspective of the intracoronary surface morphology, and reasonably accurate information regarding a specific lesion, if performed by trained technicians. Intravascular ultrasound (IVUS) is an alternative imaging modality that provides real-time tomographic images of blood vessels on a monitor. It generates information on vessel wall structure, atheroma volume, and the echogenicity of plaque, which is amenable to qualitative and quantitative analysis and can be used to evaluate plaque regression. 9 The effects of statins on coronary plaque have been evaluated by angioscopy, as well as IVUS, in patients with hypercholesterolemia. Using angioscopy, Takano et al demonstrated that the grade of yellow color decreased during statin therapy, 10 and Nissen et al 11 and Okazaki et al 12 used IVUS to investigate the effects of statins on atheroma volume. However, because no study has serially monitored the coronary plaques of patients receiving statin therapy using both angioscopy and IVUS, the relationship between changes in plaque color and changes in atheroma volume has not been elucidated. Therefore, we used both imaging modalities concurrently to investigate the qualitative and quantitative changes over time in coronary plaques in patients receiving atorvastatin therapy to reduce LDL-C levels to ≤100 mg/dl. Methods Study PopulationPatients with coronary artery disease (CAD) complicated by hypercholesterolemia, with a fasting LDL-C level (Received August 10, 2008; accepted December 2, 2008; released online February 18, 2009

One-year lipid-lowering therapy by fluvastatin showed significant regression of plaque volume and alterations in atherosclerotic plaque composition with a significant reduction of fibro-fatty volume.