Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York.
Cardiovascular Research Foundation, New York, New York.
JACC Cardiovasc Imaging. 2014 Jan;7(1):70-8. doi: 10.1016/j.jcmg.2013.10.007.
This study investigated coronary artery remodeling patterns associated with clinical outcomes.
In the prospective, multicenter PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree: An Imaging Study in Patients With Unstable Atherosclerotic Lesions) study, reported predictors of nonculprit lesion (NCL) major adverse cardiac events (MACE) were an intravascular ultrasound (IVUS) minimal lumen area (MLA) ≤4 mm(2), a plaque burden ≥70%, and a IVUS-virtual histology (VH) thin-cap fibroatheroma (TCFA), but not lesion site remodeling.
Overall, 697 consecutive patients with an acute coronary syndrome were enrolled and underwent 3-vessel gray-scale and IVUS-VH; 3,223 NCLs were identified by IVUS. The remodeling index (RI) was calculated as the external elastic membrane area at the MLA site divided by the average of the proximal and distal reference external elastic membrane areas. First, one third of the patients were randomly selected to determine RI cutoffs related to NCL MACE (development cohort). Receiver-operating characteristic analysis showed that there were 2 separate cut points that predicted NCL MACE: RI = 0.8789 and RI = 1.0046 (area under the curve = 0.663). These cut points were used to define negative remodeling as an RI <0.88, intermediate remodeling as an RI of 0.88 to 1.00, and positive remodeling as an RI >1.00. Second, we used the remaining two-thirds of patients to validate these cut points with respect to lesion morphology and clinical outcomes (validation cohort).
Kaplan-Meier curve analysis in the validation cohort showed that NCL MACE occurred more frequent (and equally) in negative and positive remodeling lesions compared with intermediate remodeling lesions. In this cohort, negative remodeling lesions had the smallest MLA, positive remodeling lesions had the largest plaque burden, and VH TCFA, especially VH TCFA with multiple necrotic cores, was most common in negatively remodeling lesions.
The present study showed the novel concept that positive and negative lesion site remodeling was associated with unanticipated NCL MACE in the PROSPECT study. (
An Imaging Study in Patients With Unstable Atherosclerotic Lesions [PROSPECT]; NCT00180466).
本研究旨在探讨与临床结局相关的冠状动脉重构模式。
在前瞻性、多中心的 PROSPECT（提供观察预测事件的区域结果：不稳定粥样斑块患者的影像学研究）研究中，报告了非罪犯病变（NCL）主要不良心脏事件（MACE）的预测因素包括血管内超声（IVUS）最小管腔面积（MLA）≤4mm2、斑块负荷≥70%以及 IVUS-虚拟组织学（VH）薄帽纤维粥样瘤（TCFA），但不包括病变部位重构。
共纳入 697 例急性冠状动脉综合征患者，进行 3 支血管灰阶和 IVUS-VH 检查；通过 IVUS 确定 3223 个 NCL。重构指数（RI）的计算方法为在 MLA 部位测量外膜面积与近端和远端参考外膜面积的平均值之比。首先，随机选择三分之一的患者来确定与 NCL MACE 相关的 RI 截止值（发展队列）。接收者操作特征分析显示，存在 2 个独立的截断点可以预测 NCL MACE：RI=0.8789 和 RI=1.0046（曲线下面积=0.663）。这些截断点用于定义 RI<0.88 为负性重构，RI 在 0.88 至 1.00 之间为中间性重构，RI>1.00 为正性重构。其次，我们使用剩余的三分之二的患者来验证这些截断点与病变形态和临床结局的关系（验证队列）。
验证队列的 Kaplan-Meier 曲线分析显示，与中间性重构病变相比，NCL MACE 在负性和正性重构病变中更频繁（且同样）发生。在该队列中，负性重构病变的 MLA 最小，正性重构病变的斑块负荷最大，VH TCFA，尤其是具有多个坏死核心的 VH TCFA，在负性重构病变中最为常见。
本研究表明了一个新的概念，即病变部位的正性和负性重构与 PROSPECT 研究中未预料到的 NCL MACE 相关。（PROSPECT：不稳定粥样斑块患者的影像学研究[PROSPECT]；NCT00180466）。
