Progression of coronary atherosclerosis in stable patients with ultrasonic features of high-risk plaques

Aim Large plaque burden, expansive vascular remodelling, and spotty calcification have been considered as important morphologies of high-risk plaques causing acute coronary events. Although non-occlusive rupture of high-risk plaques has been proposed as a mechanism for disease progression in post-mortem studies, the natural history of coronary atherosclerosis in stable patients with high-risk plaques has not been fully elucidated. We sought to evaluate coronary atheroma progressionin stable patients with greyscale intravascular ultrasound (IVUS)-derived high-risk plaques. Methods and results We analysed 4477 patients with stable coronary artery disease underwent serial greyscale IVUS imaging in eight clinical trials.We compared volumetric intravascular ultrasound (IVUS) data in the non-culprit segments between patients with and without high-risk plaques, defined as the combination of per cent atheroma volume (PAV) .63%, positive remodelling and spotty calcification. High-risk plaques were observed in 201 (4.5%) of patients. Patients with high-risk plaques exhibited a greater PAV (47.1±8.4 vs. 37.7±8.7%, P< 0.001) at baseline. On serial evaluation, however, regression of PAV (20.26±0.39 vs. 0.24±0.32%, P = 0.03) was observed. In patients with high-risk plaques, the non-statin usewas associated with the accelerated atheroma progression, whereas atheroma regressionwas observed under statin therapy (change in PAV: 1.87±0.68% vs.-0.83±0.53%, P = 0.01). Conclusions Patients with high-risk plaques exhibit extensive atheroma burden, which is modifiable with anti-atherosclerotic therapies. These findings underscore risk modification using a statin in patients with high-risk plaques.