Role of Low Endothelial Shear Stress and Plaque Characteristics in the Prediction of Nonculprit Major Adverse Cardiac Events
| Autor: | Dimitris Fotiadis, Charles Maynard, Marina Zaromytidou, Charles L. Feldman, Michail I. Papafaklis, Akiko Maehara, Ioannis Andreou, Gary S. Mintz, Kostas A. Stefanou, Gerasimos Siasos, Ahmet U. Coskun, Lampros K. Michalis, Peter Stone, Alexandra J. Lansky, Gregg W. Stone, Patrick W. Serruys |
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| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Pathology Acute coronary syndrome business.industry 030204 cardiovascular system & hematology medicine.disease Coronary artery disease Lesion Large plaque 03 medical and health sciences 0302 clinical medicine Internal medicine Coronary plaque Risk stratification Propensity score matching medicine Cardiology Radiology Nuclear Medicine and imaging cardiovascular diseases 030212 general & internal medicine medicine.symptom Cardiology and Cardiovascular Medicine business Mace |
| Zdroj: | JACC: Cardiovascular Imaging. 11:462-471 |
| ISSN: | 1936-878X |
| DOI: | 10.1016/j.jcmg.2017.01.031 |
| Popis: | Objectives This study sought to determine whether low endothelial shear stress (ESS) adds independent prognostication for future major adverse cardiac events (MACE) in coronary lesions in patients with high-risk acute coronary syndrome (ACS) from the United States and Europe. Background Low ESS is a proinflammatory, proatherogenic stimulus associated with coronary plaque development, progression, and destabilization in human-like animal models and in humans. Previous natural history studies including baseline ESS characterization investigated low-risk patients. Methods In the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study, 697 patients with ACS underwent 3-vessel intracoronary imaging. Independent predictors of MACE attributable to untreated nonculprit (nc) coronary lesions during 3.4-year follow-up were large plaque burden (PB), small minimum lumen area (MLA), and thin-cap fibroatheroma (TCFA) morphology. In this analysis, baseline ESS of nc lesions leading to new MACE (nc-MACE lesions) and randomly selected control nc lesions without MACE (nc-non-MACE lesions) were calculated. A propensity score for ESS was constructed for each lesion, and the relationship between ESS and subsequent nc-MACE was examined. Results A total of 145 lesions were analyzed in 97 patients: 23 nc-MACE lesions (13 TCFAs, 10 thick-cap fibroatheromas [ThCFAs]), and 122 nc-non-MACE lesions (63 TCFAs, 59 ThCFAs). Low local ESS ( Conclusions Local low ESS provides incremental risk stratification of untreated coronary lesions in high-risk patients, beyond measures of PB, MLA, and morphology. |
| Databáze: | OpenAIRE |
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