Vulnerable atherosclerotic plaques of coronary arteries in patients with stable coronary artery disease: 12-months follow-up

Relevance. A key objective of modern cardiology is the assessment of acute coronary syndrome (ACS) risk in patients with coronary artery disease (CAD) to develop preventive measures and choose optimal treatment strategies.
Objective. Detect vulnerable plaques of non-target coronary arteries in patients with stable CAD during routine percutaneous coronary intervention using virtual-histology intravascular ultrasound (VH-IVUS) and view their morphology over time.
Materials and Methods. The prospective observational cohort study included 58 patients with stable CAD. After stenting of a target vessel, VH-IVUS was carried out in proximal and middle segments (6–8 cm) of a non-target coronary artery with no significant stenosis according to coronary angiography. Twelve months later, all patients underwent coronary angiography with re-IVUS of previously detected lesions. Death, myocardial infarction, rehospitalization, and unplanned myocardial revascularization due to vulnerable plaques were the endpoints of the study.
Results. IVUS with virtual histology revealed 58 lesions of non-target coronary arteries in 56 (96.5 %) patients. Two patients had no lesions in non-target coronary arteries. A large necrotic core with thin cap (thin-cap fibroatheroma) was detected in 12 (20.7 %) plaques, six of which had additional ACS risk criteria (stenosis area >70 % and / or lumen area <4 mm2). Within the 12‑month follow-up period, three patients (one with a vulnerable plaque in IVUS) were hospitalized with a clinical picture of ACS. One cardiac death was registered in a patient with the IVUS vulnerable plaque. 7 of 12 vulnerable plaques stabilized in 12 months.
Conclusion. 1) The data presented indicate a high rate (20.7 %) of vulnerable plaques of non-target coronary arteries in patients with stable CAD who underwent stenting; 2) Two (16.6 %) patients with vulnerable plaques reached endpoints (death and rehospitalization) within the 12‑month follow-up period; 3) An analysis of atherosclerotic plaques in non-target coronary arteries over time showed that vulnerable plaques stabilized and did not cause ACS in more than half of cases (7 of 12); 4) Plaques that were not vulnerable according to IVUS were not likely to destabilize within the 12‑month follow-up period.

1. Kochergin N.A., Kochergina A.M. Intravascular Ultrasound Studies and the Vulnerable Atherosclerotic Plaque (Literature Review). Medical Visualization. 2017;21(4):82–7. In Russian DOI: 10.24835/1607-0763-2017-4-82-87

2. Virmani R, Burke AP, Farb A, Kolodgie FD. Pathology of the Vulnerable Plaque. Journal of the American College of Cardiology. 2006;47(8):C13–8. DOI: 10.1016/j.jacc.2005.10.065

3. Tagieva N.R., Shakhnovich R.M., Mironov V.M., Ezhov M.V., Matchin Yu.G., Mitroshkin M.G. et al. Comparison of Atherosclerotic Lesions in Patients with Acute Myocardial Infarction and Stable Angina Pectoris Using Intravascular Ultrasound. Kardiologiia. 2015;55 (7): 5–13. In Russian

4. Glaser R, Selzer F, Faxon DP, Laskey WK, Cohen HA, Slater J et al. Clinical Progression of Incidental, Asymptomatic Lesions Discovered During Culprit Vessel Coronary Intervention. Circulation. 2005;111(2):143–9. DOI: 10.1161/01.CIR.0000150335.01285.12

5. García-García H, Mintz G, Lerman A, Vince G, Margolis P, van Es G-A et al. Tissue characterisation using intravascular radiofrequency data analysis: recommendations for acquisition, analysis, interpretation and reporting. EuroIntervention. 2009;5(2):177–89. DOI: 10.4244/EI-JV5I2A29

6. Kaul S, Diamond GA. Improved Prospects for IVUS in Identifying Vulnerable Plaques? JACC Cardiovascular Imaging. 2012; 5 (3 Suppl):S106–10. DOI: 10.1016/j.jcmg.2012.02.001

7. Calvert PA, Obaid DR, O’Sullivan M, Shapiro LM, McNab D, Densem CG et al. Association Between IVUS Findings and Adverse Outcomes in Patients with Coronary Artery Disease: the VIVA (VH-IVUS in Vulnerable Atherosclerosis) Study. JACC: Cardiovascular Imaging. 2011;4(8):894–901. DOI: 10.1016/j.jcmg.2011.05.005

8. Cheng JM, Garcia-Garcia HM, de Boer SPM, Kardys I, Heo JH, Akkerhuis KM et al. In vivo detection of high-risk coronary plaques by radiofrequency intravascular ultrasound and cardiovascular outcome: results of the ATHEROREMO-IVUS study. European Heart Journal. 2014;35(10):639–47. DOI: 10.1093/eurheartj/eht484

9. Sinclair H, Veerasamy M, Bourantas C, Egred M, Nair A, Calvert PA et al. The Role of Virtual Histology Intravascular Ultrasound in the Identification of Coronary Artery Plaque Vulnerability in Acute Coronary Syndromes: Cardiology in Review. 2016;24(6):303–9. DOI: 10.1097/CRD.0000000000000100

10. KocherginN.A.,KocherginaA.M.,GanjukovV.I.,BarbarashO.L.Vulnerable atherosclerotic plaques of coronary arteries in patients with stable coronary artery disease. Complex Issues of Cardiovascular Diseases. 2018;7 (3):65–71. In Russian DOI: 10.17802/2306-1278-2018-7-3-65-71

11. Stone GW, Maehara A, Lansky AJ, de Bruyne B, Cristea E, Mintz GS et al. A Prospective Natural-History Study of Coronary Atherosclerosis. New England Journal of Medicine. 2011;364(3):226–35. DOI: 10.1056/NEJMoa1002358