{"id":6029,"date":"2011-01-19T17:07:52","date_gmt":"2011-01-19T22:07:52","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?p=6029"},"modified":"2011-07-19T17:44:14","modified_gmt":"2011-07-19T21:44:14","slug":"what-prospect-doesnt-tell-us","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2011\/01\/19\/what-prospect-doesnt-tell-us\/","title":{"rendered":"What PROSPECT Doesn’t Tell Us"},"content":{"rendered":"

The<\/span> PROSPECT trial<\/a> provides some interesting insights\u00a0about the mechanisms of thrombotic coronary artery disease, but\u00a0how, if at all, should it change practice?\u00a0Here are\u00a0what the findings do and do not demonstrate:<\/span><\/span><\/p>\n

What the PROSPECT study says:<\/span><\/strong><\/p>\n

In ACS patients treated with PCI, major adverse cardiovascular events that occurred during a <\/span>median follow-up of 3.4 years were as likely to result from a nonculprit ( i.e., other than the originally stented) lesion as \u00a0from the culprit lesion. \u00a0These nonculprit lesions often were angiographically mild (\u224830% stenosis) and were characterized (with IVUS) as having thin-cap fibroatheroma, a large plaque burden, a small luminal area, or some combination of these.<\/span><\/p>\n

What the PROSPECT study doesn\u2019t<\/em> say:<\/span><\/strong><\/p>\n

    \n
  1. ACS most commonly results from mild lesions. <\/em><\/strong>Major cardiovascular events were equally attributable <\/em>to recurrence at the site of PCI and to nonculprit lesions.<\/span><\/li>\n
  2. Mild lesions with thin caps, large plaque burdens, and small lumens carry a high risk of causing MI and death. <\/em><\/strong>In fact, of the lesions with all three of these characteristics, only 18% resulted in a cardiovascular event, the most frequent of which was hospitalization for unstable or progressive angina (in 93% of patients).\u00a0\u00a0Death, MI, or cardiac arrest occurred in only 7% of patients.<\/span><\/li>\n
  3. Patients should have IVUS of their entire coronary tree to identify \u201chigh risk\u201d lesions. <\/em><\/strong>In this study, <\/em><\/strong>1.6% of patients had complications (dissection or perforation) related to the 3-vessel imaging procedure. \u00a0Furthermore, of the 222 lesions leading to events, only 55 were prospectively \u201cidentified\u201d by IVUS; 118 occurred at the sites of lesions treated with PCI, and 49 occurred in distal vessels inaccessible to IVUS.<\/span><\/li>\n
  4. Mild angiographic stenoses should undergo revascularization. <\/em><\/strong>No data exist to suggest that revascularization of \u201cvulnerable\u201d lesions prevents acute events. \u00a0In fact, revascularization may be harmful: 13% of stented lesions were subsequently the site of a cardiovascular event.<\/span><\/li>\n<\/ol>\n

    Do you see any expanded role for IVUS after this study? Will you do anything different in your practice on\u00a0the\u00a0basis\u00a0of these results?<\/span><\/em><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

    The PROSPECT trial provides some interesting insights\u00a0about the mechanisms of thrombotic coronary artery disease, but\u00a0how, if at all, should it change practice?\u00a0Here are\u00a0what the findings do and do not demonstrate: What the PROSPECT study says: In ACS patients treated with PCI, major adverse cardiovascular events that occurred during a median follow-up of 3.4 years were […]<\/p>\n","protected":false},"author":214,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11,1,9],"tags":[239,666,301,667],"class_list":["post-6029","post","type-post","status-publish","format-standard","hentry","category-cardiac-imaging","category-general","category-interventional-cardiology","tag-acs","tag-ivus","tag-pci","tag-prospect-study"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/6029","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/214"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=6029"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/6029\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=6029"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=6029"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=6029"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}