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Characteristics and clinical significance of angiographically mild lesions in acute coronary syndromes.
MedLine Citation:
PMID:  22421235     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
OBJECTIVES: The aim of this study was to assess whether residual nonculprit (NC) lesions, defined as visual diameter stenosis ≥30% after successful percutaneous coronary intervention, affect the rate of future events in patients with acute coronary syndromes.
BACKGROUND: In patients with acute coronary syndromes, approximately one-half of recurrent events after percutaneous coronary intervention arise from untreated lesions.
METHODS: Patients enrolled in PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) were divided into 3 groups: those with no NC lesions, 1 NC lesion, or ≥2 NC lesions. Time to events for major adverse cardiac events was estimated up to 3 years.
RESULTS: Among 697 patients, 13.3% had no NC lesions, 19.7% had 1 NC lesion, and 67.0% had ≥2 NC lesions. The median diameter stenoses of the NC lesions in the latter 2 groups were 36.7% (interquartile range: 31.0% to 43.4%) and 37.4% (interquartile range: 32.0% to 46.5%), respectively (p = 0.22). At least 1 thin-cap fibroatheroma was present in one-half the patients in each group. At 3 years, the incidence of major adverse cardiac events was 8.5%, 15.2%, and 24.3%, respectively (p = 0.0009). NC lesion-related events occurred in 0%, 5.0%, and 15.9% of patients, respectively (p < 0.0001). Of 105 NC lesion-related clinical events occurring during follow-up, 73 (69.5%) originated from angiographically evident baseline NC lesions (of which 36 had diameter stenosis >50%), while the other 32 arose from normal or near normal segments.
CONCLUSIONS: Residual NC lesions are common after percutaneous coronary intervention for acute coronary syndromes and portend a higher rate of recurrent ischemic events within 3 years, especially when angiographically more severe. Conversely, the absence of NC lesions by angiography is highly predictive of freedom from events not related to the originally treated culprit lesion(s).
Authors:
Sorin J Brener; Gary S Mintz; Ecaterina Cristea; Giora Weisz; Akiko Maehara; John A McPherson; Steven P Marso; Naim Farhat; Hans Erik Botker; Ovidiu Dressler; Ke Xu; Barry Templin; Zhen Zhang; Alexandra J Lansky; Bernard de Bruyne; Patrick W Serruys; Gregg W Stone
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  JACC. Cardiovascular imaging     Volume:  5     ISSN:  1876-7591     ISO Abbreviation:  JACC Cardiovasc Imaging     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-03-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101467978     Medline TA:  JACC Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S86-94     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Affiliation:
New York Methodist Hospital, Brooklyn, New York; Cardiovascular Research Foundation, New York, New York.
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