Relationship between changes in coronary atherosclerotic plaque burden measured by intravascular ultrasound and cardiovascular disease outcomes: a systematic literature review

Abstract

Objective Evidence from coronary imaging studies suggests an association between increased atherosclerotic plaque burden and cardiovascular disease (CVD) outcomes. A systematic review was performed to evaluate the relationship between coronary atherosclerotic plaque burden changes measured by intravascular ultrasound (IVUS) and CVD outcomes.

Research design and methods Rigorous systematic review methodology was used to identify prospective studies of any design assessing the relationship between atherosclerotic plaque volume (percentage or total atheroma volume [PAV or TAV]) changes and CVD outcomes, using multivariable analyses.

Main outcome measures CVD outcomes including major adverse cardiac events (MACEs) and major adverse cardiac and cerebrovascular events (MACCEs).

Results Literature searches from inception to February 2015 retrieved 6958 records after de-duplication. From these four studies (14 papers) were included. One study reported a significantly lower rate of CVD outcomes associated with a greater reduction in PAV (hazard ratio [HR] 0.26, 95% confidence interval [CI] 0.07–0.83). One study reported that large plaque volume was significantly associated with a greater risk of major adverse cardiac events (MACEs) (HR 1.73, 95% CI: 1.02–2.96). Similarly, a third study reported a significant increase in MACE with an increase in baseline PAV (HR 1.51, 95% CI: 1.06–2.51). Only one potentially inadequately powered Japanese study did not find a statistically significant relationship between PAV changes and MACE.

Conclusions The current evidence suggests an independent and statistically significant association between increases in coronary atherosclerotic plaque burden measured by IVUS and greater long-term risk of future CVD outcomes. However, this evidence comes from a limited number of studies which mainly focus on Japanese populations and populations after PCI. Further large prospective studies are required to confirm these findings.

Keywords:

• Atherosclerosis
• Atherosclerotic plaque
• Cardiovascular diseases
• Risk factors
• Systematic review

Declaration of funding

This study was funded by Amgen Inc. (Thousand Oaks, CA, USA).

Declaration of financial/other relationships

R.G.W.Q., S.R.G. and H.K. have disclosed that they are Amgen Inc. employees and stockholders. N.D.W. and S.J.N. have disclosed that they serve as Amgen Inc. consultants/advisory board participants. S.J.N. has disclosed that he has received research support from Amgen. C.F., S.D., G.W., J.R. and J.K. have disclosed that they are employees of Kleijnen Systematic Reviews (KSR) Ltd, an independent research company who have been funded by Amgen Inc. to carry out this work.

CMRO peer reviewers have received an honorarium from CMRO for their review work, but have no relevant financial or other relationships to disclose.

Acknowledgments

The authors acknowledge the help of the following researchers who assisted with data extraction and quality assessment: Debra Fayter, Shona Lang, Kim Reid and Adrian Hernandez.