Effect of Culprit-Lesion Remodeling Versus Plaque Rupture on Three-Year Outcome in Patients With Acute Coronary Syndrome

Okura, Hiroyuki; Kobayashi, Yoshio; Sumitsuji, Satoru; Terashima, Mitsuyasu; Kataoka, Toru; Masutani, Motomaru; Ohyanagi, Mitsumasa; Shimada, Kenei; Taguchi, Haruyuki; Yasuga, Yuji; Takeda, Yoshihiro; Ohashi, Yoshitaka; Awano, Kojiro; Fujii, Kenichi; Mintz, Gary S.

doi:10.1016/j.amjcard.2008.11.030

Cited by 25 publications

(18 citation statements)

References 22 publications

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“…In addition to plaque characteristics, remodeling index was a conventional IVUS predictor of OCT-derived TCFA. This is quite concordant with the previous IVUS studies demonstrating that positive arterial remodeling is a characteristic finding of the ACS (22)(23)(24) and thus a marker of vulnerable or high-risk plaque (5,16,(25)(26)(27). Our present study further demonstrated the direct correlation between plaque components and thickness of the fibrous cap.…”

Section: Discussionsupporting

confidence: 95%

Plaque Characteristics of Thin-Cap Fibroatheroma Evaluated by OCT and IVUS

Miyamoto

Okura

Kume

et al. 2011

JACC: Cardiovascular Imaging

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Section: Discussionsupporting

confidence: 95%

Plaque Characteristics of Thin-Cap Fibroatheroma Evaluated by OCT and IVUS

Miyamoto

Okura

Kume

et al. 2011

JACC: Cardiovascular Imaging

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“…In addition, 39.5% of patients with ACS had other coronary plaque lesions derived from a culprit lesion related to the event 20) . Vulnerable plaque in non-target vessels is reportedly an important predictor of future critical cardiac events in IVUS studies 21) ; therefore, plaque regression in another coronary lesion could lead to the suppression of other events. We also considered that clinical outcome would be a more desirable and valid endpoint than simple plaque burden.…”

Section: Discussionmentioning

confidence: 99%

Plaque Regression Determined by Intravascular Ultrasound Predicts Long-Term Outcomes of Patients with Acute Coronary Syndrome

Dohi

Miyauchi

Okazaki

et al. 2011

JAT

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Aim:The usefulness of drugs to treat plaque regression is assessed by intravascular ultrasound (IVUS); however, the impact of plaque regression on clinical outcomes in patients with acute coronary syndrome (ACS) has not been established; therefore, we investigated the relationship between coronary plaque regression and long-term clinical outcomes. Methods: We analyzed data from 86 patients who underwent percutaneous coronary intervention (PCI) and who were assessed in detail at baseline and at 6 months of follow-up by measuring proximal non-culprit sites of PCI lesions using volumetric IVUS. Patients were divided according to changes in plaque volume over 6 months into one group with plaque regression (n 55; 64.0%) and another with progression (n 31; 36.0%). They were followed up observationally for a mean of 1,736 days. Results: Baseline characteristics at the time of ACS were similar between the groups. The probability of event-free survival was significantly higher in the regression group than in the progression group as estimated by the Kaplan-Meier method (Log-rank test, p 0.032). Furthermore, the Cox hazards model revealed the relative contribution of plaque regression as a predictor of cardiovascular events (hazard ratio: 0.26; 95% CI, 0.07 to 0.83; p 0.023). Conclusions: Plaque regression determined by volumetric IVUS over a period of 6 months was associated with a lower rate of cardiovascular events among patients with ACS. This study also demonstrated that plaque regression could be a surrogate marker of future cardiovascular events. J Atheroscler Thromb, 2011; 18:231-239.

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“…[3][4][5][6] Moreover, recent 3-vessel IVUS studies have also revealed that plaque rupture may be present not only in the culprit lesion but also in nonculprit lesions. [5][6][7][8][9] Those multiple plaque ruptures have been reported in 16% to 79% of the patients with ACS, 3,[5][6][7][8][9][10] suggesting the presence of pan-coronary artery vulnerability, possibly as a result of systemic inflammation. 8 Although a possible link between coronary arterial vulnerability and carotid arterial instability was suspected, the incidence and clinical significance of plaque rupture in the peripheral arteries have not been fully investigated.…”

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Incidence and Predictors of Plaque Rupture in the Peripheral Arteries

Okura

Asawa

Kubo

et al. 2010

Circ: Cardiovascular Interventions

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Background-Plaque rupture may be present in the peripheral arteries of the patients at high risk for cardiovascular events and is possibly associated with vascular vulnerability. Methods and Results-One hundred one iliofemoral arteries from 101 patients undergoing angioplasty were studied.Intravascular ultrasound imaging was performed before intervention. Plaque rupture was defined as presence of a cavity that communicated with the lumen with an overlying residual fibrous cap fragment. Incidence, numbers, and location of the plaque rupture were investigated. Plaque rupture was found in 42 of 101 arteries (42%). Patients with plaque rupture had significantly higher prevalence of acute coronary syndrome than did patients without plaque rupture (42% vs 16%, Pϭ0.01). By multivariable logistic regression analysis, acute coronary syndrome (Pϭ0.004) and male sex (Pϭ0.01) were independent clinical correlates of plaque rupture. During follow-up (median, 14.7 months), the incidence of major adverse cardiac or cerebrovascular events (death, myocardial infarction, and ischemic stroke) was similar between the 2 groups. The incidence of major adverse cardiac or cerebrovascular events plus peripheral vascular events (unplanned vascular intervention and amputation) was significantly higher in patients with plaque rupture than in patients without plaque rupture (46% vs 21%, Pϭ0.008). By multivariable Cox regression analysis, plaque rupture (hazard ratioϭ2.80, 95% CI: 1.23 to 6.37, Pϭ0.01) and Fontaine stage IV (hazard ratioϭ3.50, 95% CI: 1.58 to 7.71, Pϭ0.002) were independent predictors of major adverse cardiac or cerebrovascular events plus peripheral vascular events. Conclusions-Ruptured plaque of the iliofemoral arteries is a common finding. Patients with plaque rupture had a higher prevalence of history of acute coronary syndrome and lower major adverse cardiac or cerebrovascular events plus peripheral vascular event-free survival. (Circ Cardiovasc Interv. 2010;3:63-70.)

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Effect of Culprit-Lesion Remodeling Versus Plaque Rupture on Three-Year Outcome in Patients With Acute Coronary Syndrome

Cited by 25 publications

References 22 publications

Plaque Characteristics of Thin-Cap Fibroatheroma Evaluated by OCT and IVUS

Plaque Characteristics of Thin-Cap Fibroatheroma Evaluated by OCT and IVUS

Plaque Regression Determined by Intravascular Ultrasound Predicts Long-Term Outcomes of Patients with Acute Coronary Syndrome

Incidence and Predictors of Plaque Rupture in the Peripheral Arteries

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