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Objectives: The aim of this study was to use angiography and grayscale and intravascular ultrasoundvirtual histology to assess coronary lesions that caused events during a median follow-up period of 3.4 years. Background: Vulnerable plaque-related events are assumed to be the result of substantial progression of insignificant lesions. Methods: In the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study, 697 patients with acute coronary syndromes underwent treatment of all culprit lesions followed by 3-vessel imaging to assess the natural history of culprit and untreated nonculprit (NC) lesions. Future adverse cardiovascular events adjudicated to NC lesions were divided into those with versus without substantial lesion progression (SLP) (20% angiographic diameter stenosis increase). Results: NC lesion events occurred in 72 patients, 44 (61%) with and 28 (39%) without SLP. Myocardial infarctions (n = 6) occurred only in patients with SLP. Conversely, patients without SLP presented only with unstable or increasing angina requiring rehospitalization. Lesions with versus without SLP occurred later (median time to event 401 vs. 223 days, p = 0.07); were less severe at baseline (median diameter stenosis 26.4% vs. 53.8%, p 0.0001) but more severe at the time of the event (mean diameter stenosis 73.8% vs. 56%, p 0.0001); and had comparable baseline median plaque burden (68.7% vs. 70.1%, p = 0.17), minimum luminal area (3.7 vs. 4.0 mm 2, p = 0.60), and intravascular ultrasoundvirtual histology phenotype (83.3% vs. 90.9%, p = 0.68; classified as fibroatheromas at baseline). Conclusions: NC lesions responsible for future cardiovascular events showed angiographic increase during 3.4 years of follow-up, whereas SLP underlay many but not all of them. NC events due to lesions with SLP were angiographically less severe and presented with a delayed time course but were otherwise indistinguishable from NC events that were not associated with SLP.
机译：目的：本研究的目的是使用血管造影，灰度和血管内超声虚拟组织学评估在3.4年中位随访期内引起事件的冠状动脉病变。背景：易损斑块相关事件被认为是无关紧要的病变实质发展的结果。方法：在PROSPECT（为研究冠状动脉事件的预测因素提供区域观察）研究中，对697例急性冠脉综合征患者进行了所有罪魁祸首的治疗，然后进行3血管成像以评估罪犯和未经治疗的非罪犯的自然病史（ NC）病变。判定为NC病变的未来不良心血管事件分为有或无实质病变进展（SLP）的患者（<20％血管造影直径狭窄增加）。结果：NC病变事件发生在72例患者中，有SLP的有44例（61％），有28例的39例（39％）。心肌梗塞（n = 6）仅发生在SLP患者中。相反，没有SLP的患者仅表现为不稳定或增加的心绞痛，需要再次住院。有或没有SLP的病变发生较晚（事件401的中位时间vs 223天，p = 0.07）;在基线时较轻（中位直径狭窄26.4％vs. 53.8％，p <0.0001），但在事件发生时更严重（平均直径狭窄73.8％vs. 56％，p <0.0001）;并具有可比的基线中度斑块负担（68.7％vs. 70.1％，p = 0.17），最小管腔面积（3.7 vs. 4.0 mm 2，p = 0.60）和血管内超声虚拟组织学表型（83.3％vs. 90.9％，p = 0.68;在基线时被分类为纤维状动脉瘤。结论：负责未来心血管事件的NC病变在3.4年的随访中显示血管造影增加，而SLP覆盖了许多但不是全部。由于SLP病变引起的NC事件在血管造影上的严重程度较低，并且具有延迟的病程，但与与SLP不相关的NC事件没有区别。

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