Impact of Coronary Plaque Vulnerability on Acute Cardiovascular Events – Design of a CT-based 2-year Follow-up Study

Open access

Abstract

With coronary artery disease (CAD) projected to remain the leading cause of global mortality, prevention strategies seem to be the only effective approach able to reduce the burden and improve mortality and morbidity. At this moment, diagnostic strategies focus mainly on symptomatic patients, ignoring the occurrence of major cardiovascular events as the only manifestation of CAD. As two thirds of fatal myocardial infarction are resulting from plaque rupture, an approach based on the “vulnerable plaque” concept is mandatory in order to improve patient diagnosis, treatment, and, by default, prognosis. Given that the main studies focus on a plaque-centered approach, this is a prospective observational study that will perform a complex assessment of the features that characterize unstable coronary lesions, in terms of both local assessment via specific coronary computed tomography angiography markers of coronary plaque vulnerability and systemic approach based on serological markers of systemic inflammation in patients proved to be “vulnerable” by developing acute cardiovascular events.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1. Roger VL Go AS Lloyd-Jones DM et al. Heart Disease and Stroke Statistics—2011 Update: A Report From the American Heart Association. Circulation. 2011;123:e18-e209.

  • 2. Park K. Park’s Textbook of Preventive and Social Medicine. Jabalpur: M/S Banarsidas Bhanot; 2011.

  • 3. Barton GR Irvine L Flather M McCann GP Curzen N Gershlick AH. Economic Evaluation of Complete Revascularization for Patients with Multivessel Disease Undergoing Primary Percutaneous Coronary Intervention. Value Health. 2017;20:745-751.

  • 4. Braunwald E. Epilogue: What Do Clinicians Expect From Imagers? J Am Coll Cardiol. 2006;47:C101-C103.

  • 5. Maurovich-Horvat P Ferencik M Voros S Merkely B Hoffmann U. Comprehensive plaque assessment by coronary CT angiography. Nat Rev Cardiol. 2014;11:390-402.

  • 6. Mohler ER Sarov-Blat L Shi Y et al. Site-Specific Atherogenic Gene Expression Correlates With Subsequent Variable Lesion Development in Coronary and Peripheral Vasculature. Arterioscler Thromb Vasc Biol. 2008;28:850-855.

  • 7. Box LC Angiolillo DJ Suzuki N et al. Heterogeneity of atherosclerotic plaque characteristics in human coronary artery disease: A three-dimensional intravascular ultrasound study. Catheter Cardiovasc Interv. 2007;70:349-356.

  • 8. Narula J Garg P Achenbach S Motoyama S Virmani R Strauss HW. Arithmetic of vulnerable plaques for noninvasive imaging. Nat Clin Pract Cardiovasc Med. 2008;5:S2-S10.

  • 9. Finn AV Nakano M Narula J Kolodgie FD Virmani R. Concept of Vulnerable/Unstable Plaque. Arterioscler Thromb Vasc Biol. 2010;30:1282-1292.

  • 10. Virmani R Kolodgie FD Burke AP Farb A Schwartz SM. Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions. Arterioscler Thromb Vasc Biol. 2000;20:1262-1275.

  • 11. Huang X Yang C Zheng J et al. 3D MRI-based multicomponent thin layer structure only plaque models for atherosclerotic plaques. J Biomech. 2016;49:2726-2733.

  • 12. Davies MJ. A macro and micro view of coronary vascular insult in ischemic heart disease. Circulation. 1990;82:II38-46.

  • 13. Narula J Finn AV DeMaria AN. Picking Plaques That Pop. J Am Coll Cardiol. 2005;45:1970-1973.

  • 14. Naghavi M Libby P Falk E et al. From Vulnerable Plaque to Vulnerable Patient: A Call for New Definitions and Risk Assessment Strategies: Part I. Circulation. 2003;108:1664-1672.

  • 15. Schaar J. Terminology for high-risk and vulnerable coronary artery plaques. Eur Heart J. 2004;25:1077-1082.

  • 16. Schoenhagen P Ziada KM Kapadia SR Crowe TD Nissen SE Tuzcu EM. Extent and Direction of Arterial Remodeling in Stable Versus Unstable Coronary Syndromes: An Intravascular Ultrasound Study. Circulation. 2000;101:598-603.

  • 17. Hassani S-E Mintz GS Fong HS et al. Negative Remodeling and Calcified Plaque in Octogenarians With Acute Myocardial Infarction. J Am Coll Cardiol. 2006;47:2413-2419.

  • 18. Kolodgie FD. Pathologic assessment of the vulnerable human coronary plaque. Heart. 2004;90:1385-1391.

  • 19. Heidenreich PA Trogdon JG Khavjou OA et al. Forecasting the Future of Cardiovascular Disease in the United States: A Policy Statement From the American Heart Association. Circulation. 2011;123:933-944.

  • 20. Waxman S Ishibashi F Muller JE. Detection and Treatment of Vulnerable Plaques and Vulnerable Patients: Novel Approaches to Prevention of Coronary Events. Circulation. 2006;114:2390-2411.

  • 21. Achenbach S Friedrich MG Nagel E et al. CV Imaging: What Was New in 2012? JACC Cardiovasc Imaging. 2013;6:714-734.

  • 22. Achenbach S Raggi P. Imaging of coronary atherosclerosis by computed tomography. Eur Heart J. 2010;31:1442-1448.

  • 23. Falk E Nakano M Bentzon JF Finn AV Virmani R. Update on acute coronary syndromes: the pathologists’ view. Eur Heart J. 2013;34:719-728.

  • 24. Narula J Nakano M Virmani R et al. Histopathologic Characteristics of Atherosclerotic Coronary Disease and Implications of the Findings for the Invasive and Noninvasive Detection of Vulnerable Plaques. J Am Coll Cardiol. 2013;61:1041-1051.

  • 25. Ferencik M Schlett CL Ghoshhajra BB et al. A Computed Tomography-Based Coronary Lesion Score to Predict Acute Coronary Syndrome Among Patients With Acute Chest Pain and Significant Coronary Stenosis on Coronary Computed Tomographic Angiogram. Am J Cardiol. 2012;110:183-189.

  • 26. Stefanadis C Antoniou C Tsiachris D Pietri P. Coronary Atherosclerotic Vulnerable Plaque: Current Perspectives. J Am Heart Assoc. 2017;6:e005543.

  • 27. Conte E Annoni A Pontone G et al. Evaluation of coronary plaque characteristics with coronary computed tomography angiography in patients with non-obstructive coronary artery disease: a long-term follow-up study. Eur Heart J Cardiovasc Imaging. 2017;18:1170-1178.

  • 28. Motoyama S Sarai M Harigaya H et al. Computed Tomographic Angiography Characteristics of Atherosclerotic Plaques Subsequently Resulting in Acute Coronary Syndrome. J Am Coll Cardiol. 2009;54:49-57.

  • 29. Otsuka K Fukuda S Tanaka A et al. Napkin-Ring Sign on Coronary CT Angiography for the Prediction of Acute Coronary Syndrome. JACC Cardiovasc Imaging. 2013;6:448-457.

  • 30. Achenbach S Ropers D Hoffmann U et al. assessment of coronary remodeling in stenotic and nonstenotic coronary atherosclerotic lesions by multidetector spiral computed tomography. J Am Coll Cardiol. 2004;43:842-847.

  • 31. Koenig W Khuseyinova N. Biomarkers of Atherosclerotic Plaque Instability and Rupture. Arterioscler Thromb Vasc Biol. 2007;27:15-26.

  • 32. The Emerging Risk Factors Collaboration. C-Reactive Protein Fibrinogen and Cardiovascular Disease Prediction. N Engl J Med. 2012;367:1310-1320.

  • 33. Galis ZS Khatri JJ. Matrix metalloproteinases in vascular remodeling and atherogenesis: the good the bad and the ugly. Circ Res. 2002;90:251-262.

  • 34. 2013 ESC guidelines on the management of stable coronary artery disease: The Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34:2949-3003.

  • 35. Davies MJ. The Composition of Coronary-Artery Plaques. N Engl J Med. 1997;336:1312-1314.

  • 36. Burke AP Farb A Malcom GT Liang YH Smialek J Virmani R. Coronary risk factors and plaque morphology in men with coronary disease who died suddenly. N Engl J Med. 1997;336:1276-1282.

  • 37. Virmani R Burke AP Farb A Kolodgie FD. Pathology of the vulnerable plaque. J Am Coll Cardiol. 2006;47:C13-C18.

  • 38. Motoyama S Kondo T Sarai M et al. Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes. J Am Coll Cardiol. 2007;50:319-326.

  • 39. Yamagishi M Terashima M Awano K et al. Morphology of vulnerable coronary plaque: insights from follow-up of patients examined by intravascular ultrasound before an acute coronary syndrome. J Am Coll Cardiol. 2000;35:106-111.

  • 40. Grønholdt ML Nordestgaard BG Wiebe BM Wilhjelm JE Sillesen H. Echolucency of computerized ultrasound images of carotid atherosclerotic plaques are associated with increased levels of triglyceride-rich lipoproteins as well as increased plaque lipid content. Circulation. 1998;97:34-40.

  • 41. Davies MJ Thomas AC. Plaque fissuring-the cause of acute myocardial infarction sudden ischaemic death and crescendo angina. Br Heart J. 1985;53:363-373.

  • 42. Falk E. Morphologic features of unstable atherothrombotic plaques underlying acute coronary syndromes. Am J Cardiol. 1989;63:114E-120E.

  • 43. Farb A Burke AP Tang AL et al. Coronary plaque erosion without rupture into a lipid core. A frequent cause of coronary thrombosis in sudden coronary death. Circulation. 1996;93:1354-1363.

  • 44. Fernández-Ortiz A Badimon JJ Falk E et al. Characterization of the relative thrombogenicity of atherosclerotic plaque components: implications for consequences of plaque rupture. J Am Coll Cardiol. 1994;23:1562-1569.

  • 45. Kitagawa T Yamamoto H Horiguchi J et al. Characterization of noncalcified coronary plaques and identification of culprit lesions in patients with acute coronary syndrome by 64-slice computed tomography. JACC Cardiovasc Imaging. 2009;2:153-160.

  • 46. Hoffmann U Moselewski F Nieman K et al. Noninvasive assessment of plaque morphology and composition in culprit and stable lesions in acute coronary syndrome and stable lesions in stable angina by multidetector computed tomography. J Am Coll Cardiol. 2006;47:1655-1662.

  • 47. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet Lond Engl. 1994;344:1383-1389.

  • 48. Liuzzo G Biasucci LM Gallimore JR et al. The Prognostic Value of C-Reactive Protein and Serum Amyloid A Protein in Severe Unstable Angina. N Engl J Med. 1994;331:417-424.

  • 49. Cristell N Cianflone D Durante A et al. High-Sensitivity C-Reactive Protein Is Within Normal Levels at the Very Onset of First ST-Segment Elevation Acute Myocardial Infarction in 41% of Cases. J Am Coll Cardiol. 2011;58:2654-2661.

  • 50. Scalone G Niccoli G Refaat H et al. Not all plaque ruptures are born equal: an optical coherence tomography study. Eur Heart J – Cardiovasc Imaging. 2017;18:1271-1277.

Search
Journal information
Metrics
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 39 39 10
PDF Downloads 13 13 1