Picking the plaques that go pop

Another exciting day in Barcelona. The highlight for me was a session dedicated to imaging of atherosclerosis, both from within the coronary arteries and non-invasively. My take-home message was that whilst we have many ways of quantifying the extent, structure and functional state of atherosclerosis in the coronary arteries and elsewhere, we are still in desperate need of prospective trials in this area. It is all very well to image atheroma; as clinicians we need to know more - we need to know which patients will suffer CV events in the future. We can choose from risk scores, such as Framingham. We can use circulating biomarkers - CRP, lipids and many others. And finally imaging of atherosclerosis. How to bring them all together?

Thankfully, there are a couple of very interesting trials underway. The first is the High Risk Plaque BioImage study, co-ordinated by BG Medicine in USA. This large, prospective, event-driven study in asymptomatic subjects has already recruited over 5000 patients for imaging (CT, MRI, FDG PET, IMT, calcium score) plus biomarkers. Over the next 3 years, CV events will occur in these patients; as a result we will discover the true 'predictability' of these modalities.

The second trial of huge interest is the PROSPECT study, due to be reported at TCT in San Francisco in late September. This focusses on invasive plaque assessment with coronary angiography, palpography and IVUS-VH and again attempts to predict events on the basis of imaging and circulating biomarkers over a 3 year period.

Let us know in the comments your thoughts on invasive and non-invasive plaque imaging.