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Coronary Atherosclerotic Precursors of Acute Coronary Syndromes

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dc.contributor.author장혁재-
dc.contributor.author이상은-
dc.date.accessioned2018-08-28T17:25:55Z-
dc.date.available2018-08-28T17:25:55Z-
dc.date.issued2018-
dc.identifier.issn0735-1097-
dc.identifier.urihttps://ir.ymlib.yonsei.ac.kr/handle/22282913/162599-
dc.description.abstractBACKGROUND: The association of atherosclerotic features with first acute coronary syndromes (ACS) has not accounted for plaque burden. OBJECTIVES: The purpose of this study was to identify atherosclerotic features associated with precursors of ACS. METHODS: We performed a nested case-control study within a cohort of 25,251 patients undergoing coronary computed tomographic angiography (CTA) with follow-up over 3.4 +/- 2.1 years. Patients with ACS and nonevent patients with no prior coronary artery disease (CAD) were propensity matched 1:1 for risk factors and coronary CTA-evaluated obstructive (>/=50%) CAD. Separate core laboratories performed blinded adjudication of ACS and culprit lesions and quantification of baseline coronary CTA for percent diameter stenosis (%DS), percent cross-sectional plaque burden (PB), plaque volumes (PVs) by composition (calcified, fibrous, fibrofatty, and necrotic core), and presence of high-risk plaques (HRPs). RESULTS: We identified 234 ACS and control pairs (age 62 years, 63% male). More than 65% of patients with ACS had nonobstructive CAD at baseline, and 52% had HRP. The %DS, cross-sectional PB, fibrofatty and necrotic core volume, and HRP increased the adjusted hazard ratio (HR) of ACS (1.010 per %DS, 95% confidence interval [CI]: 1.005 to 1.015; 1.008 per percent cross-sectional PB, 95% CI: 1.003 to 1.013; 1.002 per mm(3) fibrofatty plaque, 95% CI: 1.000 to 1.003; 1.593 per mm(3) necrotic core, 95% CI: 1.219 to 2.082; all p < 0.05). Of the 129 culprit lesion precursors identified by coronary CTA, three-fourths exhibited <50% stenosis and 31.0% exhibited HRP. CONCLUSIONS: Although ACS increases with %DS, most precursors of ACS cases and culprit lesions are nonobstructive. Plaque evaluation, including HRP, PB, and plaque composition, identifies high-risk patients above and beyond stenosis severity and aggregate plaque burden.-
dc.description.statementOfResponsibilityrestriction-
dc.languageEnglish-
dc.publisherElsevier Biomedical-
dc.relation.isPartOfJOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY-
dc.rightsCC BY-NC-ND 2.0 KR-
dc.rightshttps://creativecommons.org/licenses/by-nc-nd/2.0/kr/-
dc.titleCoronary Atherosclerotic Precursors of Acute Coronary Syndromes-
dc.typeArticle-
dc.contributor.collegeCollege of Medicine-
dc.contributor.departmentDept. of Internal Medicine-
dc.contributor.googleauthorHyuk-Jae Chang-
dc.contributor.googleauthorFay Y Lin-
dc.contributor.googleauthorSang-Eun Lee-
dc.contributor.googleauthorDaniele Andreini-
dc.contributor.googleauthorJeroen Bax-
dc.contributor.googleauthorFilippo Cademartiri-
dc.contributor.googleauthorKavitha Chinnaiyan-
dc.contributor.googleauthorBenjamin J W Chow-
dc.contributor.googleauthorEdoardo Conte-
dc.contributor.googleauthorRicardo C Cury-
dc.contributor.googleauthorGudrun Feuchtner-
dc.contributor.googleauthorMartin Hadamitzky-
dc.contributor.googleauthorYong-Jin Kim-
dc.contributor.googleauthorJonathon Leipsic-
dc.contributor.googleauthorErica Maffei-
dc.contributor.googleauthorHugo Marques-
dc.contributor.googleauthorFabian Plank-
dc.contributor.googleauthorGianluca Pontone-
dc.contributor.googleauthorGilbert L Raff-
dc.contributor.googleauthorAlexander R van Rosendael-
dc.contributor.googleauthorTodd C Villines-
dc.contributor.googleauthorHarald G Weirich-
dc.contributor.googleauthorSubhi J Al'Aref-
dc.contributor.googleauthorLohendran Baskaran-
dc.contributor.googleauthorIksung Cho-
dc.contributor.googleauthorIbrahim Danad-
dc.contributor.googleauthorDonghee Han-
dc.contributor.googleauthorRan Heo-
dc.contributor.googleauthorJi Hyun Lee-
dc.contributor.googleauthorAsim Rivzi-
dc.contributor.googleauthorWijnand J Stuijfzand-
dc.contributor.googleauthorHeidi Gransar-
dc.contributor.googleauthorYao Lu-
dc.contributor.googleauthorJi Min Sung-
dc.contributor.googleauthorHyung-Bok Park-
dc.contributor.googleauthorDaniel S Berman-
dc.contributor.googleauthorMatthew J Budoff-
dc.contributor.googleauthorHabib Samady-
dc.contributor.googleauthorLeslee J Shaw-
dc.contributor.googleauthorPeter H Stone-
dc.contributor.googleauthorRenu Virmani-
dc.contributor.googleauthorJagat Narula-
dc.contributor.googleauthorJames K Min-
dc.identifier.doi10.1016/j.jacc.2018.02.079-
dc.contributor.localIdA03490-
dc.relation.journalcodeJ01770-
dc.identifier.eissn1558-3597-
dc.identifier.pmid29852975-
dc.identifier.urlhttps://www.sciencedirect.com/science/article/pii/S0735109718343717-
dc.subject.keywordacute coronary syndrome-
dc.subject.keywordatherosclerosis-
dc.subject.keywordclinical outcome-
dc.subject.keywordcoronary artery disease-
dc.subject.keywordcoronary computed tomography angiography-
dc.contributor.alternativeNameChang, Hyuck Jae-
dc.contributor.affiliatedAuthorChang, Hyuck Jae-
dc.citation.volume71-
dc.citation.number22-
dc.citation.startPage2511-
dc.citation.endPage2522-
dc.identifier.bibliographicCitationJOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Vol.71(22) : 2511-2522, 2018-
dc.identifier.rimsid60179-
dc.type.rimsART-
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers

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