CARDIAC CATH LAB - Mount Sinai Hospital

Participation in clinical
trials including the
PROSPECT trial has
contributed to our
knowledge of vulnerable
plaques, which often
elude detection under
traditional screening.
Pedro Moreno, MD, Director
Interventional Research,
Cardiac Cath Lab, on
Advances in Vulnerable
Plaque Treatment
Despite steady improvement in the
medical and interventional treatment
of coronary artery disease, we
continue to struggle with the fact
that contemporary PCI, as good as it is,
may not prevent an MI or even death
in the seemingly stable patient. This is
because life-threatening heart attacks
arise most often from lesions — the
so-called vulnerable plaques that escape conventional imaging technology.
Recently Mount Sinai’s cath lab participated in the first large-scale
systematic effort to change this condition, the PROSPECT Clinical Trial.
This prospective study to evaluate the role of vulnerable plaque in the
progression of coronary artery disease tracked 700 patients with acute
coronary syndrome (ACS) in a three-year multicenter trial. After treating
the precipitating lesion, and with patient consent, investigators went
on to investigate the presence and composition of additional nonculprit,
nonstenotic lesions (2,600 in all) in the three major arteries. Many of
these lesions were not detectable in stress tests or coronary angiograms.
However, using newly introduced imaging technology called virtual
histology — an advanced version of intravascular ultrasound — we were
able to systematically analyze plaque composition with regard to size
and thickness on the basis of the distinct spectral parameters of each
tissue substrate.
From this data we went on to correlate various plaque characteristics,
patient risk factors and plasma markers with plaque progression and
adverse cardiac events that subsequently occurred among participants.
The results — based on literally hundreds of thousands of frames
viewed by VH-IVUS and angiography — gave us a statistical picture
of the common features of these nonocclusive lesions, which turn
out to be more dangerous than occlusive hard plaques.
22 Mount Sinai Hospital Cardiac Cath Lab