TY - JOUR
T1 - Relationship between left main coronary artery plaque burden and nonleft main coronary atherosclerosis
T2 - Results from the PROSPECT study
AU - Shimizu, Takehisa
AU - Mintz, Gary S.
AU - De Bruyne, Bernard
AU - Farhat, Naim Z.
AU - Inaba, Shinji
AU - Cao, Yang
AU - Marso, Steven P.
AU - Weisz, Giora
AU - Serruys, Patrick W.
AU - Stone, Gregg W.
AU - Maehara, Akiko
N1 - Funding Information:
Dr. Shimizu received grant funding from the Japan Heart Foundation and Bayer Yakuhin Research Grant Abroad. Dr. Mintz is a consultant at Boston Scientific and ACIST; has fellowship/grant support from Volcano, Boston Scientific, and InfraReDx; and received honoraria from Boston Scientific and ACIST. Dr. De Bruyne received institutional grant support and consulting fees from Abbott, Biotronik, and Boston Scientific. Dr. Steven Marso is a consultant at St Jude Medical, Novo Nordisk, and The Medicines Company; received research grants from Bristol-Myers Squibb, Novo Nordisk, Terumo, The Medicines Company, and Volcano Corporation. Dr. Weisz is an advisory board member of AngioSlide, Corindus, Filterlex, M.I. Medical Incentive, Medivizor, TriSol, and Vectorious. Dr. Serruys is a consultant at Abbott, Biosensors, Cardialysis, Micell Technologies, Medtronic, Sinomed Science Technologies, Stentys France, Svelte Medical Systems, Philips/Volcano, St. Jude Medical, and Xeltis. Dr. Stone is an employer at Columbia University and receives royalties for sale of the MitraClip. Dr. Maehara received Institutional grant support from Boston Scientific and St. Jude Medical; is a consultant at Boston Scientific and OCT Medical Imaging Inc.; and received speaker fee from St. Jude Medical. For the remaining authors, there are no conflicts of interest.
Publisher Copyright:
© 2018 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2018/8/1
Y1 - 2018/8/1
N2 - Objectives Whether the severity of left main coronary artery (LMCA) disease reflects LMCA and overall coronary atherosclerotic burden is not known. We aimed to assess nonculprit LMCA disease characteristics and the relationship with atherosclerosis in the rest of the coronary arteries as well as patient outcomes. Patients and methods In the PROSPECT study, 697 patients with acute coronary syndromes underwent three-vessel gray-scale and radiofrequency intravascular ultrasound after percutaneous coronary intervention. Results Overall, 552 patients with adequate LMCA imaging were compared according to LMCA plaque burden. The tertile with the highest plaque burden in the LMCA had the smallest LMCA minimum lumen area (17.4, 14.2, 10.5, lowest through highest tertiles, respectively, P<0.0001) and the greatest percent necrotic core volume (2.8, 5.6, 9.5%, lowest through highest tertiles, respectively, P<0.0001). Furthermore, the tertile with the highest plaque burden was also significantly associated with the highest overall non-LMCA percent atheroma volume within the major epicardial arteries (48.3, 49.2, 50.8%, lowest through highest tertiles, respectively, P<0.0001). After adjusting for patient background, the LMCA plaque burden was independently associated with non-LMCA percent atheroma volume (P=0.003). Of the three PROSPECT predictors of future nonculprit major adverse cardiac events (MACE) (minimum lumen area≤4 mm 2, plaque burden≥70%, and virtual histology thin-cap fibroatheroma), the tertile with the highest LMCA plaque burden had the highest number of patients with at least one of three PROSPECT predictors (P=0.03). In multivariable model, though total atheroma volume (per 1%) was an independent predictor of all MACE [hazard ratio (95% confidence interval)=1.06 (1.01-1.11), P=0.02] and strong trend for non-culprit-related MACE [hazard ratio (95% confidence interval)=1.06 (1.00-1.13), P=0.06], plaque burden at LMCA was not (all MACE, P=0.90, non-culprit-related MACE, P=0.85). Conclusion The severity of atherosclerosis in LMCA predicted the overall atherosclerotic plaque burden as well as the presence of high-risk plaques in the three major epicardial coronary arteries.
AB - Objectives Whether the severity of left main coronary artery (LMCA) disease reflects LMCA and overall coronary atherosclerotic burden is not known. We aimed to assess nonculprit LMCA disease characteristics and the relationship with atherosclerosis in the rest of the coronary arteries as well as patient outcomes. Patients and methods In the PROSPECT study, 697 patients with acute coronary syndromes underwent three-vessel gray-scale and radiofrequency intravascular ultrasound after percutaneous coronary intervention. Results Overall, 552 patients with adequate LMCA imaging were compared according to LMCA plaque burden. The tertile with the highest plaque burden in the LMCA had the smallest LMCA minimum lumen area (17.4, 14.2, 10.5, lowest through highest tertiles, respectively, P<0.0001) and the greatest percent necrotic core volume (2.8, 5.6, 9.5%, lowest through highest tertiles, respectively, P<0.0001). Furthermore, the tertile with the highest plaque burden was also significantly associated with the highest overall non-LMCA percent atheroma volume within the major epicardial arteries (48.3, 49.2, 50.8%, lowest through highest tertiles, respectively, P<0.0001). After adjusting for patient background, the LMCA plaque burden was independently associated with non-LMCA percent atheroma volume (P=0.003). Of the three PROSPECT predictors of future nonculprit major adverse cardiac events (MACE) (minimum lumen area≤4 mm 2, plaque burden≥70%, and virtual histology thin-cap fibroatheroma), the tertile with the highest LMCA plaque burden had the highest number of patients with at least one of three PROSPECT predictors (P=0.03). In multivariable model, though total atheroma volume (per 1%) was an independent predictor of all MACE [hazard ratio (95% confidence interval)=1.06 (1.01-1.11), P=0.02] and strong trend for non-culprit-related MACE [hazard ratio (95% confidence interval)=1.06 (1.00-1.13), P=0.06], plaque burden at LMCA was not (all MACE, P=0.90, non-culprit-related MACE, P=0.85). Conclusion The severity of atherosclerosis in LMCA predicted the overall atherosclerotic plaque burden as well as the presence of high-risk plaques in the three major epicardial coronary arteries.
KW - intravascular ultrasound
KW - left main coronary artery
KW - plaque burden
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UR - http://www.scopus.com/inward/citedby.url?scp=85050036707&partnerID=8YFLogxK
U2 - 10.1097/MCA.0000000000000640
DO - 10.1097/MCA.0000000000000640
M3 - Article
C2 - 29781836
AN - SCOPUS:85050036707
SN - 0954-6928
VL - 29
SP - 397
EP - 402
JO - Coronary artery disease
JF - Coronary artery disease
IS - 5
ER -