Your browser doesn't support javascript.
loading
Identification of vulnerable plaques and patients by intracoronary near-infrared spectroscopy and ultrasound (PROSPECT II): a prospective natural history study.
Erlinge, David; Maehara, Akiko; Ben-Yehuda, Ori; Bøtker, Hans Erik; Maeng, Michael; Kjøller-Hansen, Lars; Engstrøm, Thomas; Matsumura, Mitsuaki; Crowley, Aaron; Dressler, Ovidiu; Mintz, Gary S; Fröbert, Ole; Persson, Jonas; Wiseth, Rune; Larsen, Alf Inge; Okkels Jensen, Lisette; Nordrehaug, Jan Erik; Bleie, Øyvind; Omerovic, Elmir; Held, Claes; James, Stefan K; Ali, Ziad A; Muller, James E; Stone, Gregg W.
Afiliação
  • Erlinge D; Lund University, Lund, Sweden. Electronic address: david.erlinge@med.lu.se.
  • Maehara A; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA; Cardiovascular Research Foundation, New York, NY, USA.
  • Ben-Yehuda O; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA; Cardiovascular Research Foundation, New York, NY, USA; University of California San Diego, San Diego, CA, USA.
  • Bøtker HE; Aarhus University Hospital, Aarhus, Denmark.
  • Maeng M; Aarhus University Hospital, Aarhus, Denmark.
  • Kjøller-Hansen L; Zealand University Hospital, Roskilde, Denmark.
  • Engstrøm T; University of Copenhagen, Copenhagen, Denmark.
  • Matsumura M; Cardiovascular Research Foundation, New York, NY, USA.
  • Crowley A; Cardiovascular Research Foundation, New York, NY, USA.
  • Dressler O; Cardiovascular Research Foundation, New York, NY, USA.
  • Mintz GS; Cardiovascular Research Foundation, New York, NY, USA.
  • Fröbert O; Faculty of Health, Örebro University, Sweden.
  • Persson J; Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
  • Wiseth R; St Olavs Hospital, Trondheim University Hospital, Norway.
  • Larsen AI; Stavanger University Hospital, Stavanger, Norway.
  • Okkels Jensen L; Odense University Hospital, Odense, Denmark.
  • Nordrehaug JE; University of Bergen, Bergen, Norway.
  • Bleie Ø; Haukeland University Hospital, Bergen, Norway.
  • Omerovic E; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
  • Held C; Uppsala University and Uppsala Clinical Research Center, Uppsala, Sweden.
  • James SK; Uppsala University and Uppsala Clinical Research Center, Uppsala, Sweden.
  • Ali ZA; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA; Cardiovascular Research Foundation, New York, NY, USA.
  • Muller JE; Brigham and Women's Hospital, Boston, MA, USA.
  • Stone GW; Cardiovascular Research Foundation, New York, NY, USA; The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Lancet ; 397(10278): 985-995, 2021 03 13.
Article em En | MEDLINE | ID: mdl-33714389
BACKGROUND: Near-infrared spectroscopy (NIRS) and intravascular ultrasound are promising imaging modalities to identify non-obstructive plaques likely to cause coronary-related events. We aimed to assess whether combined NIRS and intravascular ultrasound can identify high-risk plaques and patients that are at risk for future major adverse cardiac events (MACEs). METHODS: PROSPECT II is an investigator-sponsored, multicentre, prospective natural history study done at 14 university hospitals and two community hospitals in Denmark, Norway, and Sweden. We recruited patients of any age with recent (within past 4 weeks) myocardial infarction. After treatment of all flow-limiting coronary lesions, three-vessel imaging was done with a combined NIRS and intravascular ultrasound catheter. Untreated lesions (also known as non-culprit lesions) were identified by intravascular ultrasound and their lipid content was assessed by NIRS. The primary outcome was the covariate-adjusted rate of MACEs (the composite of cardiac death, myocardial infarction, unstable angina, or progressive angina) arising from untreated non-culprit lesions during follow-up. The relations between plaques with high lipid content, large plaque burden, and small lumen areas and patient-level and lesion-level events were determined. This trial is registered with ClinicalTrials.gov, NCT02171065. FINDINGS: Between June 10, 2014, and Dec 20, 2017, 3629 non-culprit lesions were characterised in 898 patients (153 [17%] women, 745 [83%] men; median age 63 [IQR 55-70] years). Median follow-up was 3·7 (IQR 3·0-4·4) years. Adverse events within 4 years occurred in 112 (13·2%, 95% CI 11·0-15·6) of 898 patients, with 66 (8·0%, 95% CI 6·2-10·0) arising from 78 untreated non-culprit lesions (mean baseline angiographic diameter stenosis 46·9% [SD 15·9]). Highly lipidic lesions (851 [24%] of 3500 lesions, present in 520 [59%] of 884 patients) were an independent predictor of patient-level non-culprit lesion-related MACEs (adjusted odds ratio 2·27, 95% CI 1·25-4·13) and non-culprit lesion-specific MACEs (7·83, 4·12-14·89). Large plaque burden (787 [22%] of 3629 lesions, present in 530 [59%] of 898 patients) was also an independent predictor of non-culprit lesion-related MACEs. Lesions with both large plaque burden by intravascular ultrasound and large lipid-rich cores by NIRS had a 4-year non-culprit lesion-related MACE rate of 7·0% (95% CI 4·0-10·0). Patients in whom one or more such lesions were identified had a 4-year non-culprit lesion-related MACE rate of 13·2% (95% CI 9·4-17·6). INTERPRETATION: Combined NIRS and intravascular ultrasound detects angiographically non-obstructive lesions with a high lipid content and large plaque burden that are at increased risk for future adverse cardiac outcomes. FUNDING: Abbott Vascular, Infraredx, and The Medicines Company.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Ultrassonografia / Espectroscopia de Luz Próxima ao Infravermelho / Placa Aterosclerótica / Infarto do Miocárdio Tipo de estudo: Clinical_trials / Diagnostic_studies / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged País/Região como assunto: Europa Idioma: En Revista: Lancet Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Ultrassonografia / Espectroscopia de Luz Próxima ao Infravermelho / Placa Aterosclerótica / Infarto do Miocárdio Tipo de estudo: Clinical_trials / Diagnostic_studies / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged País/Região como assunto: Europa Idioma: En Revista: Lancet Ano de publicação: 2021 Tipo de documento: Article