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Eur Heart J Cardiovasc Imaging. 2013 Aug;14(8):758-64. doi: 10.1093/ehjci/jes228. Epub 2012 Nov 9.

Culprit lesion remodelling and long-term prognosis in patients with acute coronary syndrome: an intravascular ultrasound study.

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  • 1Division of Cardiology, Bell Land General Hospital, Sakai, Japan. hokura@fides.dti.ne.jp

Abstract

AIMS:

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 AND RESULTS:

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. 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.

CONCLUSION:

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

KEYWORDS:

Acute coronary syndrome; Intravascular ultrasound, Remodelling; Prognosis; Vulnerable plaque

PMID:
23144064
[PubMed - indexed for MEDLINE]
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