Advanced Imaging Identifies Plaques that Increase Risk of Heart Attack

September 29, 2009

Results from the PROSPECT trial "shed new light on the types of vulnerable plaque that are most likely to cause sudden, unexpected adverse cardiac events, and on the ability to identify them through imaging techniques before they occur."

According to the Cardiovascular Research Foundation (CRF), results from the Providing Regional Observations to Study Predictors of Events in the Coronary Tree (PROSPECT) trial reported at the 21st annual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium “shed new light on the types of vulnerable plaque that are most likely to cause sudden, unexpected adverse cardiac events, and on the ability to identify them through imaging techniques before they occur.”

Gregg W. Stone, MD, immediate past chairman of CRF, professor of medicine at Columbia University Hospita,l and Director of Cardiovascular Research and Education at the Center for Interventional Vascular Therapy at NewYork-Presbyterian Hospital/Columbia University Medical Center said that the because of the information learned during the PROSPECT trial, “We are closer to being able to predict—and therefore prevent—sudden, unexpected adverse cardiac events.”

During the trial, researchers used three-vessel multimodality intra-coronary imaging (angiography, intravascular ultrasound (IVUS), and virtual histology) to study 700 patients with acute coronary syndromes (ACS) in order to “quantify the clinical event rate due to atherosclerotic progression” and to identify lesions that increase patients’ risk for “unexpected adverse cardiovascular events,” including sudden death, cardiac arrest, heart attacks, and unstable or progressive angina.

The CRF reported that researchers discovered that “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 trial also “demonstrated that characterization of the underlying plaque composition (with virtual histology) was able to significantly improve the ability to predict future adverse events beyond other more standard imaging techniques.”

A separate press release from Abbot Laboratories, sponsor of the PROSPECT trial, noted that “until the PROSPECT study, no systematic effort had been made to prospectively understand the event rate associated with progression of vulnerable plaque.” But now, investigators will have access to “more than 40,000 datapoints derived from 150 variables within each of the patients [from the trial], far beyond the level of assessment of previous interventional studies.”

More information about the PROSPECT trial (which is still active, but no longer recruiting new patients) can be found here.