Abstract 3578: Local Atherosclerotic Plaques Hide Information That Is Predictive For The Occurrence Of Adverse Cardiovascular Events And Will Help To Identify The Vulnerable Patient: A Prospective Cohort Study In 667 Patients.

Abstract

Introduction Atherosclerosis is a systemic disease and the risk for ischemic events in any vascular bed increases when one arterial bed has been affected. It could be speculated that atherosclerotic lesions within the vascular bed share common denominators that destabilize multiple atherosclerotic lesions and increase risk for a subsequent cardiovascular event. We hypothesized that atherosclerotic plaques hide a cellular and molecular fingerprint that is shared by many plaques within the same individual, and that some of these characteristics would be predictive for the occurrence of clinical events due to progression of atherosclerotic disease. Methods Atherosclerotic specimens were collected after carotid endarterectomy and patients underwent clinical follow-up for the duration of 3 years. This first report summarizes the results of a study which investigated the predictive value of histological examination atherosclerotic plaques (macrophage and smooth muscle cell infiltration, collagen, calcifications, thrombus and lipid core) for the occurrence of future adverse cardiovascular events. Results A total of 164 (24.7%) of 667 patients reached the composite primary endpoint of myocardial infarction [n=11], PCI [n=14], CABG [n=6] cardiovascular death [n=12], stroke [n=24], cerebral bleeding [n=14], aneurysm surgery [n=8], peripheral artery surgery [n=64], non cardiovascular death [n=11]. The extent of macrophage or smooth muscle cell infiltration, collagen, calcification and lipid core size within the plaque did not predict systemic adverse cardiovascular events during follow up [p>0.20]. However, the presence of thrombus in the dissected plaque was strongly positively associated with reaching the primary endpoint [Cox Regression: Hazard ratio = 1.6; 95% Confidence interval = 1.1 – 2.5]. Conclusion This atherosclerotic biobank with a longitudinal study design allows identifying local plaque markers related with progression of atherosclerotic disease in the entire vascular system. For the first time we show proof of concept that local plaques hide information that may help to identify the vulnerable patient who is likely to suffer a cardiovascular event.