Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 May 14;25(5):168.
doi: 10.31083/j.rcm2505168. eCollection 2024 May.

Coronary Artery Plaque Phenotype and 5-Year Clinical Outcomes in Older Patients with Non-ST Elevation Acute Coronary Syndrome

Francesca Rubino  1   2 , Salvatore Brugaletta  3 , Gregory Mills  1   4 , Graziella Pompei  1   5 , Roberto Scarsini  2 , Flavio Ribichini  2 , Lorenz Räber  6 , Vijay Kunadian  1   4
Affiliations

Coronary Artery Plaque Phenotype and 5-Year Clinical Outcomes in Older Patients with Non-ST Elevation Acute Coronary Syndrome

Francesca Rubino et al. Rev Cardiovasc Med. .

Abstract

Background: Lesions with thin-cap fibroatheroma (TCFA), small luminal area and large plaque burden (PB) have been considered at high risk of cardiovascular events. Older patients were not represented in studies which demonstrated correlation between clinical outcome and plaque characteristics. This study aims to investigate the prognostic role of high-risk plaque characteristics and long-term outcome in older patients presenting with non-ST elevation acute coronary syndrome (NSTEACS).

Methods: This study recruited older patients aged ≥ 75 years with NSTEACS undergoing virtual-histology intravascular ultrasound (VH-IVUS) imaging from the Improve Clinical Outcomes in high-risk patieNts with acute coronary syndrome (ICON-1). Primary endpoint was the composite of major adverse cardiovascular events (MACE) consisting of all-cause mortality, myocardial infarction (MI), and any revascularisation. Every component of MACE and target vessel failure (TVF) including MI and any revascularisation were considered as secondary endpoints.

Results: Eighty-six patients with 225 vessels undergoing VH-IVUS at baseline completed 5-year clinical follow-up. Patients with minimal lumen area (MLA) ≤ 4 mm 2 demonstrated increased risk of MACE (hazard ratio [HR] 2.37, 95% confidence interval [CI] 1.00-5.59, p = 0.048) with a worse event-free survival (Log Rank 4.17, p = 0.041) than patients with MLA > 4 mm 2 . Patients with combination of TCFA, MLA ≤ 4 mm 2 and PB ≥ 70% showed high risk of MI (HR 5.23, 95% CI 1.05-25.9, p = 0.043). Lesions with MLA ≤ 4 mm 2 had 6-fold risk of TVF (HR 6.16, 95% CI 1.24-30.5, p = 0.026).

Conclusions: Small luminal area appears as the major prognostic factor in older patients with NSTEACS at long-term follow-up. Combination of TCFA, MLA ≤ 4 mm 2 and PB ≥ 70% was associated with high risk of MI.

Clinical trial registration: NCT01933581.

Keywords: major adverse cardiovascular events; minimal lumen area; non-ST elevation acute coronary syndrome; older patients; plaque burden; thin-cap fibroatheroma; virtual-histology intravascular ultrasound.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1.
Fig. 1.
Kaplan-Meier survival analysis. MACE-free survival in patients with TCFA (A), MLA ≤4 mm2 (B) and PB ≥70% (C). MACE, major adverse cardiovascular events; MLA, minimal lumen area; PB, plaque burden; TCFA, thin-cap fibroatheroma.
Fig. 2.
Fig. 2.
Brief explanation of study design. Schematic representation of plaque characteristics analysed with VH-IVUS. Association between high-risk plaque characteristics and adverse clinical events. CI, confidence interval; EEM, external elastic membrane; HR, hazard ratio; ICON1, Improve Clinical Outcomes in high-risk patieNts with acute coronary syndrome; MACE, major adverse cardiovascular events; MLA, minimal lumen area; NC, necrotic core; NSTEACS, non-ST elevation acute coronary syndrome; PB, plaque burden; TCFA, thin-cap fibroatheroma; VH-IVUS, virtual-histology intravascular ultrasound.
Fig. 3.
Fig. 3.
Kaplan-Meier survival analysis. MI-free survival in patients with TCFA and MLA ≤4 mm2 (A), TCFA and PB ≥70% (B) and combination of TCFA, MLA ≤4 mm2 and PB ≥70% (C). MI, myocardial infarction; MLA, minimal lumen area; PB, plaque burden; TCFA, thin-cap fibroatheroma.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Vaduganathan M, Mensah GA, Turco JV, Fuster V, Roth GA. The Global Burden of Cardiovascular Diseases and Risk: A Compass for Future Health. Journal of the American College of Cardiology . 2022;80:2361–2371. - PubMed
    1. Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, et al. Heart Disease and Stroke Statistics-2022 Update: A Report from the American Heart Association. Circulation . 2022;145:e153–e639. - PubMed
    1. De Luca L, Marini M, Gonzini L, Boccanelli A, Casella G, Chiarella F, et al. Contemporary Trends and Age-Specific Sex Differences in Management and Outcome for Patients With ST-Segment Elevation Myocardial Infarction. Journal of the American Heart Association . 2016;5:e004202. - PMC - PubMed
    1. Naghavi M, Libby P, Falk E, Casscells SW, Litovsky S, Rumberger J, et al. From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part I. Circulation . 2003;108:1664–1672. - PubMed
    1. Virmani R, Burke AP, Farb A, Kolodgie FD. Pathology of the vulnerable plaque. Journal of the American College of Cardiology . 2006;47:C13–C18. - PubMed

Associated data

Grants and funding

The research was supported/funded by the National Institute for Health Research (NIHR) Newcastle Biomedical Research Centre (BRC) based at Newcastle Hospitals NHS Foundation Trust and Newcastle University. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. This study was also supported by unrestricted research support from Volcano Corporation, San Diego, USA. Dr V. Kunadian has received research funding from NIHR BRC Newcastle and the British Heart Foundation (CS/15/7/31679).