Value of IVUS in Coronary Artery Disease

Oct 15, 2018
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Authors:
Schuurman AS, Vroegindewey MM, Kardys I, et al.
Citation:
Prognostic Value of Intravascular Ultrasound in Patients With Coronary Artery Disease. J Am Coll Cardiol 2018;72:2003-2011.
Summary By:
Bina Ahmed, MD, FACC

Study Questions:

What is the long-term prognostic value of grayscale and radiofrequency intravascular ultrasound (RF-IVUS)–based plaque characteristics among patients with coronary artery disease undergoing angiography?

Methods:

From 2008-2011, 581 patients underwent grayscale and RF-IVUS of a nonculprit, nonstenotic coronary artery while undergoing coronary angiography for stable angina or acute coronary syndrome (ACS). IVUS findings were analyzed and compared among those with and without major adverse cardiac events (MACE) during follow-up. MACE was defined as composite of all-cause death, nonfatal ACS, or unplanned revascularization during follow-up (median of 4.7 years).

Results:

One hundred and fifty-two patients (26.2%) had MACE. The presence of a lesion with a minimal luminal area <4.0 mm2 was independently associated with MACE (hazard ratio, 1.49; 95% confidence interval, 1.07-2.08; p = 0.020), whereas the presence of a thin-cap fibroatheroma lesion or a lesion with a plaque burden >70% on its own was not. Each 10-U increase in segmental plaque burden was independently associated with a 26% increase in risk of this composite endpoint (hazard ratio, 1.26 per 10-U increase; 95% confidence interval, 1.03-1.52; p = 0.022).

Conclusions:

Plaque extent and burden on IVUS predict adverse cardiovascular outcomes during long-term follow-up. Plaque composition as assessed by RF-IVUS did not impact outcomes.

Perspective:

The study findings suggest that presence of small luminal area on IVUS appears to be the strongest independent predictor of clinical outcomes on follow-up. Measures of plaque composition such as thin-cap fibroatheroma or plaque burden are not independently associated with long-term clinical outcomes unless they are present with other high-risk features. Regardless, presence of residual disease with small luminal area, large plaque volume, and thin-cap fibroatheroma can identify patients at high risk for recurrent events.

Keywords: Acute Coronary Syndrome, Angina, Stable, Atherosclerosis, Coronary Angiography, Coronary Artery Disease, Diagnostic Imaging, Myocardial Revascularization, Outcome Assessment, Health Care, Plaque, Atherosclerotic, Ultrasonography


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