Relationship between left main coronary artery plaque burden and nonleft main coronary atherosclerosis: Results from the PROSPECT study

Takehisa Shimizu, Gary S. Mintz, Bernard De Bruyne, Naim Z. Farhat, Shinji Inaba, Yang Cao, Steven P. Marso, Giora Weisz, Patrick W. Serruys, Gregg W. Stone, Akiko Maehara

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)397-402
Number of pages6
JournalCoronary Artery Disease
Volume29
Issue number5
DOIs
StatePublished - Aug 1 2018

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Coronary Artery Disease
Coronary Vessels
Atherosclerotic Plaques
Atherosclerosis
Confidence Intervals
Percutaneous Coronary Intervention
Acute Coronary Syndrome
Histology
Arteries

Keywords

  • intravascular ultrasound
  • left main coronary artery
  • plaque burden

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Relationship between left main coronary artery plaque burden and nonleft main coronary atherosclerosis : Results from the PROSPECT study. / Shimizu, Takehisa; Mintz, Gary S.; De Bruyne, Bernard; Farhat, Naim Z.; Inaba, Shinji; Cao, Yang; Marso, Steven P.; Weisz, Giora; Serruys, Patrick W.; Stone, Gregg W.; Maehara, Akiko.

In: Coronary Artery Disease, Vol. 29, No. 5, 01.08.2018, p. 397-402.

Research output: Contribution to journalArticle

Shimizu, T, Mintz, GS, De Bruyne, B, Farhat, NZ, Inaba, S, Cao, Y, Marso, SP, Weisz, G, Serruys, PW, Stone, GW & Maehara, A 2018, 'Relationship between left main coronary artery plaque burden and nonleft main coronary atherosclerosis: Results from the PROSPECT study', Coronary Artery Disease, vol. 29, no. 5, pp. 397-402. https://doi.org/10.1097/MCA.0000000000000640
Shimizu, Takehisa ; Mintz, Gary S. ; De Bruyne, Bernard ; Farhat, Naim Z. ; Inaba, Shinji ; Cao, Yang ; Marso, Steven P. ; Weisz, Giora ; Serruys, Patrick W. ; Stone, Gregg W. ; Maehara, Akiko. / Relationship between left main coronary artery plaque burden and nonleft main coronary atherosclerosis : Results from the PROSPECT study. In: Coronary Artery Disease. 2018 ; Vol. 29, No. 5. pp. 397-402.
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title = "Relationship between left main coronary artery plaque burden and nonleft main coronary atherosclerosis: Results from the PROSPECT study",
abstract = "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.",
keywords = "intravascular ultrasound, left main coronary artery, plaque burden",
author = "Takehisa Shimizu and Mintz, {Gary S.} and {De Bruyne}, Bernard and Farhat, {Naim Z.} and Shinji Inaba and Yang Cao and Marso, {Steven P.} and Giora Weisz and Serruys, {Patrick W.} and Stone, {Gregg W.} and Akiko Maehara",
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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

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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