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Intravascular Ultrasound-Derived Measures of Coronary Atherosclerotic Plaque Burden and Clinical Outcome
Open accessAbstract
Objectives The aim of this study was to investigate the relationship between intravascular ultrasound (IVUS)-derived measures of atherosclerosis and cardiovascular outcomes.Background IVUS has been used in clinical trials to evaluate the effect of medical therapies on coronary atheroma progression.Methods Coronary plaque progression was evaluated in 4,137 patients in 6 clinical trials that used serial IVUS. The relationship between baseline and change in percent atheroma volume (PAV) and total atheroma volume with incident major adverse cardiovascular events (MACE) was investigated.Results PAV increased by 0.3% (p < 0.001), and 19.9% of subjects experienced MACE (0.9% death, 1.8% myocardial infarction, 18.9% coronary revascularization). Greater baseline PAVs were observed in patients who experienced myocardial infarctions (42.2 +/- 9.6% vs. 38.6 +/- 9.1%, p = 0.001), coronary revascularization (41.2 +/- 9.3% vs. 38.1 +/- 9.0%, p < 0.001), or MACE (41.3 +/- 9.2% vs. 38.0 +/- 9.0%, p < 0.001). Each standard deviation increase in PAV was associated with a 1.32-fold (95% confidence interval: 1.22 to 1.42; p < 0.001) greater likelihood of experiencing a MACE. During follow-up (21.1 +/- 3.7 months), greater increases in PAV, but not total atheroma volume, were observed in subjects who experienced MACE compared with those who did not (0.95 +/- 0.19% vs. 0.46 +/- 0.16%, p < 0.001). Each standard deviation increase in PAV was associated with a 1.20-fold (95% confidence interval: 1.10 to 1.31; p < 0.001) greater risk for MACE. Multivariate analysis revealed that factors associated with MACE included baseline PAV (p < 0.0001), change in PAV (p = 0.002), smoking (p = 0.0002) and hypertension (p = 0.01).Conclusions A direct relationship was observed between the burden of coronary atherosclerosis, its progression, and adverse cardiovascular events. The relationship between disease progression and outcomes largely reflected the need for coronary revascularization. These data support the use of atherosclerosis imaging with IVUS in the evaluation of novel antiatherosclerotic therapies.
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“Combination therapy using statin and PCSK9 inhibitor prevents ASCVD incidence in patients with a history of myocardial infarction, nonhemorrhagic stroke, or PAD. (Evidence level 1+, recommendation level: B).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [639]
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Metadata
- Authors
- Nicholls, S. J., Hsu, A., Wolski, K., Hu, B., Bayturan, O., Lavoie, A., Uno, K., Tuzcu, E. M., & Nissen, S. E.
- Affiliations
- Cleveland Clinic (US)
- Corresponding author
- Nicholls, Stephen J.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2010-05
- Volume
- 55
- Issue
- 21
- Pages
- 2399-2407
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2054455620
- Cited by
- 475
- References
- 29
- Citations by year
- 2026: 20 · 2025: 15 · 2024: 15 · 2023: 25 · 2022: 31 · 2021: 22 · 2020: 24 · 2019: 33 · 2018: 35 · 2017: 32 · 2016: 52 · 2015: 40 · 2014: 41 · 2013: 29 · 2012: 24
- FWCI
- 30.17
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Institutional Repositories DataBase (IRDB) (submittedVersion)
- Funders
- Daiichi-Sankyo
- Roche
- Novo Nordisk
- Takeda Pharmaceutical Company
- Pfizer
- AstraZeneca
- Anthera
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cerebrovascular and Carotid Artery Diseases
- Keywords
- intravascular ultrasound, coronary artery disease, atheroma volume, plaque burden, major adverse cardiovascular events, myocardial infarction, coronary revascularization, plaque progression, cardiovascular risk prediction, smoking, coronary artery stenosis, coronary thrombosis
- MeSH terms
- Aged, Cardiovascular Diseases, Coronary Artery Disease, Female, Follow-Up Studies, Humans, Male, Middle Aged, Myocardial Infarction, Myocardial Revascularization, Probability, Severity of Illness Index, Cohort Studies, Multivariate Analysis, Confidence Intervals, Logistic Models, Survival Analysis, Treatment Outcome, Ultrasonography, Interventional, Disease Progression, Risk Assessment
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