Culprit Lesion Remodelling and Long-Term Prognosis in Patients With Acute Coronary Syndrome: An Intravascular Ultrasound Study

OBJECTIVES: Positive arterial remodelling is recognized as one of the morphological characteristics of the vulnerable plaque. Limited data are available on a long-term outcome of acute coronary syndrome (ACS) patients with culprit lesion positive arterial remodelling (PR). The aim of this study was to investigate the long-term impact of culprit lesion PR in patients with ACS.

METHODS: In 134 patients with ACS, intravascular ultrasound (IVUS) was performed to assess target lesion remodelling before percutaneous coronary intervention. PR was defined as the ratio of the external elastic membrane cross-sectional area at the target lesion to that of at the proximal reference of >1.05, and intermediate or negative remodelling (IR/NR) was defined as that of ≤1.05. Major adverse cardiac event (MACE) was defined as a composite of death, ACS, and target lesion revascularization.

RESULTS: During the follow-up (median 5.8 years), MACE-free survival was significantly lower in the PR group than that in the IR/NR group (log-rank, P = 0.005). Survival and ACS-free survival were also significantly lower in the PR group than that in the IR/NR group (log-rank, both P = 0.04). By multivariable Cox regression analysis, PR (hazard ratio = 2.4, P = 0.02) and diabetes (hazard ratio = 1.9, P = 0.03) were independent predictors of MACE.

CONCLUSIONS: Culprit lesion PR was associated with a poor long-term prognosis in patients with ACS. PR may be a marker of vulnerable patients. 

PMID: 23144064

Posted in Computed Tomography, Invasive Imaging and tagged , , , , , .

One Comment

  1. See also:

    Positive Remodeling of the Coronary Arteries Detected by Magnetic Resonance Imaging in an Asymptomatic Population: MESA (Multi-Ethnic Study of Atherosclerosis).
    Miao C, Chen S, Macedo R, Lai S, Liu K, Li D, Wasserman BA, Vogel-Claussen J, Lima JA, Bluemke DA.
    J Am Coll Cardiol. 2009; 53(18):1708-1715.

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