Coronary imaging trial zeroes in on plaque risk

A large prospective trial found plaque burden and plaques involving small lumen area are as likely as classically defined vulnerable plaques to trigger a myocardial infarction.

The Providing Regional Observations to Study Predictors of Events in the Coronary Tree (PROSPECT) trial is the first study of atherosclerosis using multimodality imaging. Principal investigator Dr. Gregg W. Stone and colleagues at New York-Presbyterian Hospital/Columbia University Medical Center studied 700 patients with acute coronary syndromes using angiography, intravascular ultrasound, and virtual histology analysis of IVUS-acquired radiofrequency data.

Most untreated plaques that cause unexpected heart attacks are not mild lesions, as previously thought, but actually have a large plaque burden and a small lumen area, the researchers found. These characteristics were invisible on the coronary angiogram but easily identifiable on IVUS. Findings were released at the 2009 Transcatheter Cardiovascular Therapeutics scientific symposium in San Francisco.