TY - JOUR
T1 - Characteristics and clinical significance of angiographically mild lesions in acute coronary syndromes
AU - Brener, Sorin J.
AU - Mintz, Gary S.
AU - Cristea, Ecaterina
AU - Weisz, Giora
AU - Maehara, Akiko
AU - McPherson, John A.
AU - Marso, Steven P.
AU - Farhat, Naim
AU - Botker, Hans Erik
AU - Dressler, Ovidiu
AU - Xu, Ke
AU - Templin, Barry
AU - Zhang, Zhen
AU - Lansky, Alexandra J.
AU - De Bruyne, Bernard
AU - Serruys, Patrick W.
AU - Stone, Gregg W.
N1 - Funding Information:
Dr. Mintz has received grant support and consulting fees from Volcano ; grant support and honoraria from Boston Scientific , and honoraria from St. Jude . Dr. Maehara has received research grant support from Boston Scientific and speaker fees from Volcano. Dr. McPherson is a consultant from Abbott Vascular, CardioDx, and Gilead Sciences. Dr. Marso reports no personal conflicts of interest during the pervious 12 months; all compensation for his research activities, including grants and consulting fees from The Medicines Company , Novo Nordisk , Abbott Vascular , Amylin Pharmaceuticals , Boston Scientific , Volcano Corp. , and Terumo Medical , are paid directly to Saint Luke's Hospital Foundation of Kansas City. Dr. Stone is a consultant for Abbott Vascular, Medtronic, Boston Scientific, Volcano, and InfraReDx. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
PY - 2012/3
Y1 - 2012/3
N2 - Objectives: The aim of this study was to assess whether residual nonculprit (NC) lesions, defined as visual diameter stenosis <30% after successful percutaneous coronary intervention, affect the rate of future events in patients with acute coronary syndromes. Background: In patients with acute coronary syndromes, approximately one-half of recurrent events after percutaneous coronary intervention arise from untreated lesions. Methods: Patients enrolled in PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) were divided into 3 groups: those with no NC lesions, 1 NC lesion, or <2 NC lesions. Time to events for major adverse cardiac events was estimated up to 3 years. Results: Among 697 patients, 13.3% had no NC lesions, 19.7% had 1 NC lesion, and 67.0% had <2 NC lesions. The median diameter stenoses of the NC lesions in the latter 2 groups were 36.7% (interquartile range: 31.0% to 43.4%) and 37.4% (interquartile range: 32.0% to 46.5%), respectively (p = 0.22). At least 1 thin-cap fibroatheroma was present in one-half the patients in each group. At 3 years, the incidence of major adverse cardiac events was 8.5%, 15.2%, and 24.3%, respectively (p = 0.0009). NC lesionrelated events occurred in 0%, 5.0%, and 15.9% of patients, respectively (p < 0.0001). Of 105 NC lesionrelated clinical events occurring during follow-up, 73 (69.5%) originated from angiographically evident baseline NC lesions (of which 36 had diameter stenosis >50%), while the other 32 arose from normal or near normal segments. Conclusions: Residual NC lesions are common after percutaneous coronary intervention for acute coronary syndromes and portend a higher rate of recurrent ischemic events within 3 years, especially when angiographically more severe. Conversely, the absence of NC lesions by angiography is highly predictive of freedom from events not related to the originally treated culprit lesion(s).
AB - Objectives: The aim of this study was to assess whether residual nonculprit (NC) lesions, defined as visual diameter stenosis <30% after successful percutaneous coronary intervention, affect the rate of future events in patients with acute coronary syndromes. Background: In patients with acute coronary syndromes, approximately one-half of recurrent events after percutaneous coronary intervention arise from untreated lesions. Methods: Patients enrolled in PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) were divided into 3 groups: those with no NC lesions, 1 NC lesion, or <2 NC lesions. Time to events for major adverse cardiac events was estimated up to 3 years. Results: Among 697 patients, 13.3% had no NC lesions, 19.7% had 1 NC lesion, and 67.0% had <2 NC lesions. The median diameter stenoses of the NC lesions in the latter 2 groups were 36.7% (interquartile range: 31.0% to 43.4%) and 37.4% (interquartile range: 32.0% to 46.5%), respectively (p = 0.22). At least 1 thin-cap fibroatheroma was present in one-half the patients in each group. At 3 years, the incidence of major adverse cardiac events was 8.5%, 15.2%, and 24.3%, respectively (p = 0.0009). NC lesionrelated events occurred in 0%, 5.0%, and 15.9% of patients, respectively (p < 0.0001). Of 105 NC lesionrelated clinical events occurring during follow-up, 73 (69.5%) originated from angiographically evident baseline NC lesions (of which 36 had diameter stenosis >50%), while the other 32 arose from normal or near normal segments. Conclusions: Residual NC lesions are common after percutaneous coronary intervention for acute coronary syndromes and portend a higher rate of recurrent ischemic events within 3 years, especially when angiographically more severe. Conversely, the absence of NC lesions by angiography is highly predictive of freedom from events not related to the originally treated culprit lesion(s).
KW - ACS
KW - PCI
KW - nonculprit lesions
KW - outcomes
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U2 - 10.1016/j.jcmg.2011.12.007
DO - 10.1016/j.jcmg.2011.12.007
M3 - Article
C2 - 22421235
AN - SCOPUS:84863337523
SN - 1936-878X
VL - 5
SP - S86-S94
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 3 SUPPL.
ER -