NEW YORK, NY — JANUARY 20, 2011 — Results from the PROSPECT clinical 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.
The trial, Providing Regional Observations to Study Predictors of Events in the Coronary Tree (PROSPECT), is the first prospective natural history study of atherosclerosis using multi-modality imaging to characterize the coronary tree. The study findings were published in the January 20, 2011 issue of the New England Journal of Medicine.
“As a result of the PROSPECT trial, we are closer to being able to predict — and therefore prevent — sudden, unexpected adverse cardiac events,” said principal investigator Gregg W. Stone, MD. Dr. Stone is Professor of Medicine at Columbia University College of Physicians and Surgeons, Director of Cardiovascular Research and Education at the Center for Interventional Vascular Therapy at NewYork-Presbyterian Hospital/Columbia University Medical Center and Co-Director of the Medical Research and Education Division at the Cardiovascular Research Foundation (CRF).
The multi-center 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 discoveries 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 characterization 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.
“These results mean that using a combination of imaging modalities, including IVUS to identify lesions with a large plaque burden and/or small lumen area, and VH-IVUS to identify a large necrotic core without a visible cap (a thin cap fibroatheroma) identifies the lesions that are at especially high risk of causing future adverse cardiovascular events,” Dr. Stone said.
Results of the trial were first reported at the 2009 Transcatheter Cardiovascular Therapeutics (TCT) annual scientific symposium, sponsored by CRF.
About the Cardiovascular Research Foundation
The Cardiovascular Research Foundation (CRF) is an independent, academically focused nonprofit organization dedicated to improving the survival and quality of life for people with cardiovascular disease through research and education. Since its inception in 1991, CRF has played a major role in realizing dramatic improvements in the lives of countless numbers of patients by establishing the safe use of new technologies and therapies in the subspecialty of interventional cardiology and endovascular medicine. For more information, please visit www.crf.org.
Columbia University Medical Center provides international leadership in basic, pre-clinical and clinical research, in medical and health sciences education, and in patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Established in 1767, Columbia’s College of Physicians and Surgeons was the first institution in the country to grant the M.D. degree and is now among the most selective medical schools in the country. Columbia University Medical Center is home to the most comprehensive medical research enterprise in New York City and State and one of the largest in the United States. Columbia University Medical Center is affiliated with NewYork-Presbyterian Hospital, the nation’s largest not-for-profit, non-sectarian hospital provider. For more information, please visit www.cumc.columbia.edu.
About NewYork-Presbyterian Hospital
NewYork-Presbyterian Hospital, based in New York City, is the nation’s largest not-for-profit, non-sectarian hospital, with 2,353 beds. The Hospital has more than 2 million inpatient and outpatient visits in a year, including more than 220,000 visits to its emergency departments — more than any other area hospital. NewYork-Presbyterian provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine at five major centers: NewYork-Presbyterian Hospital/Weill Cornell Medical Center, NewYork-Presbyterian Hospital/Columbia University Medical Center, NewYork-Presbyterian/Morgan Stanley Children’s Hospital, NewYork-Presbyterian/The Allen Hospital and NewYork-Presbyterian Hospital/Westchester Division. One of the most comprehensive health care institutions in the world, the Hospital is committed to excellence in patient care, research, education and community service. NewYork-Presbyterian is the #1 hospital in the New York metropolitan area and is consistently ranked among the best academic medical institutions in the nation, according to U.S.News & World Report. The Hospital has academic affiliations with two of the nation’s leading medical colleges: Weill Cornell Medical College and Columbia University College of Physicians and Surgeons. For more information, visit www.nyp.org.