A prospective natural-history study of coronary atherosclerosis

January 01, 0001

A prospective natural-history study of coronary atherosclerosis

In this prospective study by authors from multiple countries, 697 patients with acute coronary syndromes underwent three-vessel coronary angiography and gray-scale and radiofrequency intravascular ultrasonographic imaging after percutaneous coronary intervention. Subsequent major adverse cardiovascular events (death from cardiac causes, cardiac arrest, myocardial infarction, or rehospitalization due to unstable or progressive angina) were adjudicated to be related to either originally treated (culprit) lesions or untreated (nonculprit) lesions. The median follow-up period was 3.4 years.

They found: "The 3-year cumulative rate of major adverse cardiovascular events was 20.4%. Events were adjudicated to be related to culprit lesions in 12.9% of patients and to nonculprit lesions in 11.6%. Most nonculprit lesions responsible for follow-up events were angiographically mild at baseline (mean diameter stenosis, 32.3%). However, on multivariate analysis, nonculprit lesions associated with recurrent events were more likely than those not associated with recurrent events to be characterized by a plaque burden of 70% or greater (hazard ratio, 5.03) or a minimal luminal area of 4.0 mm2 or less (hazard ratio, 3.21) or to be classified on the basis of radiofrequency intravascular ultrasonography as thin-cap fibroatheromas (hazard ratio, 3.35)."

The authors concluded: "In patients who presented with an acute coronary syndrome and underwent percutaneous coronary intervention, major adverse cardiovascular events occurring during follow-up were equally attributable to recurrence at the site of culprit lesions and to nonculprit lesions. Although nonculprit lesions that were responsible for unanticipated events were frequently angiographically mild, most were thin-cap fibroatheromas or were characterized by a large plaque burden, a small luminal area, or some combination of these characteristics, as determined by gray- scale and radiofrequency intravascular ultrasonography."

These findings are likely to change what is considered to be a clinically significant atheromatous lesion.

For the full abstract, click here.

N Engl J Med 364:226-235, 20 January 20 2011
© 2011 to the Massachusetts Medical Society
A Prospective Natural-History Study of Coronary Atherosclerosis. Gregg W. Stone, Akiko Maehara, Alexandra J. Lansky, et al. Correspondence to Dr. Stone:

Category: K. Circulatory. Keywords: athrerosclerosis, acute coronary syndrome, coronary angiography, radiofrequency intravascular ultrasonography, prospective cohort study, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 1 February 2011

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