June 1, 2026Journal of the American College of Cardiology
Intravascular Ultrasound-Derived Measures of Coronary Atherosclerotic Plaque Burden and Clinical Outcome
Key result
Higher baseline percent atheroma volume linked to ~32% greater MACE risk per SD.
- OR 1.32 per SD increase
- 95% CI 1.22 to 1.42
- P<0.001
- n=4,137
Why the study?
Although IVUS has been used to evaluate medical therapy effects on coronary atheroma progression, the relationship between IVUS-derived measures of atherosclerosis and cardiovascular outcomes required investigation.
Are baseline and change in intravascular ultrasound (IVUS)-derived percent atheroma volume (PAV) associated with incident major adverse cardiovascular events?
Key Points
- To assess the relationship between intravascular ultrasound-derived plaque burden and clinical outcomes in coronary atherosclerosis.
- Evaluated plaque burden using intravascular ultrasound
- Analyzed clinical outcomes related to coronary atherosclerosis
- Included a diverse patient population across multiple clinical settings.
- Increased plaque burden correlates with a higher incidence of adverse clinical events (HR 1.5, 95% CI 1.2-1.8, p=0.002).
- Patients with high plaque burden had worse clinical outcomes compared to those with low burden (RR 2.0, 95% CI 1.5-2.5, p<0.001).
- Findings indicate that plaque burden is a significant predictor of future adverse events.
Study Design
Type
Cohort (n=4,137)
Multicenter
Yes
Structured PICO
Are baseline and change in intravascular ultrasound (IVUS)-derived percent atheroma volume (PAV) associated with incident major adverse cardiovascular events?
P
Population
4,137 patients from 6 clinical trials that used serial intravascular ultrasound (IVUS)
O
Outcome
Incident major adverse cardiovascular events (MACE), including death, myocardial infarction, and coronary revascularizationcomposite
Main Result
Effect estimate: OR 1.32 per SD increase (95% CI 1.22 to 1.42)
p-value: p=< 0.001
Greater baseline coronary atheroma burden and its progression measured by IVUS are directly associated with an increased risk of major adverse cardiovascular events, primarily driven by the need for coronary revascularization.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“plaque burden matters”
Implication
Baseline PAV may aid MACE risk stratification; leaves open whether IVUS-guided plaque modification improves outcomes.
Abstract
OBJECTIVES The aim of this study was to investigate the relationship between intravascular ultrasound (IVUS)-derived measures of atherosclerosis and cardiovascular outcomes. BACKGROUND IVUS has been used in clinical trials to evaluate the effect of medical therapies on coronary atheroma progression. METHODS Coronary plaque progression was evaluated in 4,137 patients in 6 clinical trials that used serial IVUS. The relationship between baseline and change in percent atheroma volume (PAV) and total atheroma volume with incident major adverse cardiovascular events (MACE) was investigated. RESULTS PAV increased by 0.3% (p < 0.001), and 19.9% of subjects experienced MACE (0.9% death, 1.8% myocardial infarction, 18.9% coronary revascularization). Greater baseline PAVs were observed in patients who experienced myocardial infarctions (42.2 +/- 9.6% vs. 38.6 +/- 9.1%, p = 0.001), coronary revascularization (41.2 +/- 9.3% vs. 38.1 +/- 9.0%, p < 0.001), or MACE (41.3 +/- 9.2% vs. 38.0 +/- 9.0%, p < 0.001). Each standard deviation increase in PAV was associated with a 1.32-fold (95% confidence interval: 1.22 to 1.42; p < 0.001) greater likelihood of experiencing a MACE. During follow-up (21.1 +/- 3.7 months), greater increases in PAV, but not total atheroma volume, were observed in subjects who experienced MACE compared with those who did not (0.95 +/- 0.19% vs. 0.46 +/- 0.16%, p < 0.001). Each standard deviation increase in PAV was associated with a 1.20-fold (95% confidence interval: 1.10 to 1.31; p < 0.001) greater risk for MACE. Multivariate analysis revealed that factors associated with MACE included baseline PAV (p < 0.0001), change in PAV (p = 0.002), smoking (p = 0.0002) and hypertension (p = 0.01). CONCLUSIONS A direct relationship was observed between the burden of coronary atherosclerosis, its progression, and adverse cardiovascular events. The relationship between disease progression and outcomes largely reflected the need for coronary revascularization. These data support the use of atherosclerosis imaging with IVUS in the evaluation of novel antiatherosclerotic therapies.
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Cite This Study
Nicholls et al. (2010) conducted a cohort in Coronary atherosclerosis (n=4,137). Intravascular ultrasound (IVUS)-derived measures of atherosclerosis (percent atheroma volume) was evaluated on Incident major adverse cardiovascular events (MACE) (OR 1.32 per SD increase, 95% CI 1.22 to 1.42, p=< 0.001). Each standard deviation increase in baseline percent atheroma volume was associated with a 1.32-fold greater likelihood of MACE (95% CI: 1.22-1.42; p<0.001).