Figure 1. Natural History of Coronary Artery Lesions in ACS: The PROSPECT Study.

(Top) Natural history of treated and untreated coronary artery lesions in patients with acute coronary syndromes. Incidence of major adverse cardiac events (MACE) (cardiac death, cardiac arrest, myocardial infarction, or rehospitalization due to unstable or progressive angina) at 3 years after successful percutaneous coronary intervention (PCI) for acute coronary syndrome in 697 patients from the PROSPECT study. Among the 20.4% of patients experiencing events, lesions originally treated by PCI (culprit lesions) and untreated (nonculprit) lesions accounted for nearly equal numbers of events. A small proportion of events were of indeterminate lesion origin because coronary angiography was not performed at the time of the event. (Bottom) The rate of MACE per lesion during median follow-up of 3.4 years according to the number of high-risk PROSPECT lesion characteristics at baseline. The high-risk characteristics are a plaque burden ≥70%, a minimal lumen area ≤4.0 mm², and a thin-cap fibroatheroma as assessed by virtual histology intravascular ultrasound. The fraction below the x-axis is the number of candidate lesions with each combination of events (denominator) and the number of those lesions that resulted in a MACE event during follow-up (numerator). Adapted, with permission, from Stone et al. (1).