Non-fibroatheroma lesion phenotype and long-term clinical outcomes: a substudy analysis from the PROSPECT study

JACC Cardiovasc Imaging. 2013 Aug;6(8):908-16. doi: 10.1016/j.jcmg.2013.04.008. Epub 2013 Jul 10.


Objectives: The purpose of this study was to determine the clinical impact of non-fibroatheroma lesion phenotype in patients presenting with an acute coronary syndrome (ACS).

Background: Although fibroatheromas (FAs) are known to be clinically unstable, the impact of non-FA lesion phenotype on clinical outcomes has not been studied.

Methods: In the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study, patients presenting with an ACS underwent 3-vessel grayscale and virtual histology intravascular ultrasound (VH-IVUS) after successful percutaneous intervention for all culprit lesions and were followed for 3 years. Patients were divided into those who had only the non-FA phenotype (pathological intimal thickening or fibrotic and/or fibrocalcific lesions) versus those who had at least 1 nonculprit FA.

Results: Among 2,880 nonculprit lesions identified by VH-IVUS, 39.8% were non-FAs (1,042 pathological intimal thickening, 72 fibrotic, and 33 fibrocalcific). Nonculprit major adverse cardiac events (MACE) (death, myocardial infarction, or urgent rehospitalization for progressive or unstable angina) were attributed to only 7 non-FA lesions (0.7%) versus 43 FA lesions (2.7%, p < 0.001) during 3 years follow-up. Of 609 patients, 67 (11.0%) patients had only non-FA lesion phenotypes. Patients with only non-FAs tended to be younger and more often female, have fewer nonculprit lesions and less overall plaque burden and necrotic core, and fewer nonculprit lesion MACE compared with patients with at least 1 FA. In the adjusted Cox proportional hazards model, absence of a FA was a significant predictive of a lower 3-year nonculprit MACE rate (hazard ratio: 0.23; 95% confidence interval: 0.06 to 0.95).

Conclusions: Non-FA lesions were clinically stable and were rarely associated with clinical events during 3 years of follow-up. The intermediate-term prognosis in patients presenting with ACS in whom all nonculprit lesions are non-FAs is favorable. (

Prospect: An Imaging Study in Patients With Unstable Atherosclerotic Lesions; NCT00180466).

Keywords: ACS; CSA; EEM; FA; FFR; IQR; IVUS; MACE; MI; MLA; PCI; PIT; QCA; ST-segment elevation myocardial infarction; STEMI; TCFA; ThCFA; VH; acute coronary syndromes; cross-sectional area; external elastic membrane; fibroatheroma; fractional flow reserve; interquartile range; intravascular ultrasound; major adverse cardiac event(s); minimal lumen area; myocardial infarction; non-fibroatheroma; pathological intimal thickening; percutaneous coronary intervention; plaque lesion phenotype; quantitative coronary angiography; thick-cap fibroatheroma; thin-cap fibroatheroma; virtual histology.

Publication types

  • Comparative Study
  • Multicenter Study
  • Observational Study

MeSH terms

  • Acute Coronary Syndrome / diagnostic imaging*
  • Acute Coronary Syndrome / mortality
  • Acute Coronary Syndrome / therapy
  • Age Factors
  • Aged
  • Angina, Unstable / mortality
  • Angina, Unstable / therapy
  • Chi-Square Distribution
  • Coronary Vessels / diagnostic imaging*
  • Female
  • Fibrosis
  • Hospitalization
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myocardial Infarction / mortality
  • Myocardial Infarction / therapy
  • Necrosis
  • Percutaneous Coronary Intervention
  • Phenotype
  • Plaque, Atherosclerotic
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Sex Factors
  • Time Factors
  • Treatment Outcome
  • Ultrasonography, Interventional*
  • Vascular Calcification / diagnostic imaging

Associated data