Results from the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) clinical trial have 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. The PROSPECT trial is the first prospective natural history study of atherosclerosis using multi-modality imaging to characterise the coronary tree. The study findings were published in the January 20, 2011 issue of the New England Journal of Medicine. The multi-centre trial studied 700 patients with acute coronary syndromes (ACS) using three-vessel multimodality intra-coronary imaging – angiography, grayscale intravascular ultrasound (IVUS), and radiofrequency IVUS – to quantify the clinical event rate due to atherosclerotic progression and to identify those lesions that place patients at risk for unexpected adverse cardiovascular events (sudden death, cardiac arrest, heart attacks and unstable or progressive angina). Among the findings of the trial are that most untreated plaques that cause unexpected heart attacks are not mild lesions, as previously thought, but actually have a large plaque burden and/or a small lumen area. These are characteristics that were invisible to the coronary angiogram but easily identifiable by grayscale IVUS. Moreover, and perhaps most importantly, for the first time it was demonstrated that characterisation of the underlying plaque composition (with radiofrequency IVUS, also known as VH-IVUS) was able to significantly improve the ability to predict future adverse events beyond other more standard imaging techniques. http://tinyurl.com/6f4yhvu
