(PCI) using a drug-eluting stent. A pre-speciﬁed grayscale and virtual histology (VH) intravascular ultrasound (IVUS) sub-study enrolled 2064 pts. Methods: Pre-PCI grayscale and VH-IVUS images from 916 culprit lesions in 773 pts were assessed to determine the underlying morphology. Lesions were compared between males (n¼582) vs females (n¼191) in two age groups (< 65 years and  65 years) and included plaque rupture, attenuated plaque, and VH-IVUS thin cap ﬁbroatheroma (TCFA). Results: Culprit lesion plaque ruptures were more common in males than in females overall [254/699 (36.3%) in males vs 50/217 (23.0%) in females, p<0.001] and in younger pts [159/379 (42.0%) in males vs 15/79 (19.0%) in females, p¼0.0007], but not in older pts (Table). A similar pattern was seen in VH-TCFAs both overall [373/699 (53.4%) in males vs 97/217 (44.7%) in females, p¼0.026] and in younger pts [204/379 (54.0%) in males vs 31/79 (39.0%) in females, p¼0.04], but again not in older pts. Multivariate analysis showed that male gender was an independent predictor for plaque rupture [OR:1.85 (1.26, 2.71), p¼0.0017] in addition to pre-PCI diameter stenosis [OR: 1.87 (1.57, 2.23) per 10%, p<0.0001], body mass index [OR: 1.05 (1.01, 1.08), 0.005], ST-elevation myocardial infarction [OR: 1.45 (0.99, 2.13), p¼0.06], and current smoking [OR: 1.37 (0.99, 1.90), p¼0.06]. Conclusions: There was a difference in the frequency of unstable plaque morphology in culprit lesions between male and female pts in young pts; younger male pts had more unstable plaques (plaque ruptures and VH-TCFAs) than younger female pts. However, this difference was not seen in older pts. TCT-670 Impact of Intravascular Ultrasound Tissue Characterization, in Addition to Plaque Burden and Local Endothelial Shear Stress, on the Prediction of New Adverse Cardiac Events in Humans Shingo Mizuno 1 , Michail I. Papafaklis 2 , Saeko Takahashi 3 , Masaya Tsuda 1 , Antonios Antoniadis 2 , Ahmit U. Coskun 4 , Shigeru Saito 5 , Charles Feldman 2 , Peter Stone 6 1 Brigham and Women's Hospital, Boston, MA, 2 Brigham & Women's Hospital, Harvard Medical School, Boston, MA, 3 ShonanKamakura General Hospital, Kamakura, Japan, 4 Northeastern university, Boston, MA, 5 Shonan Kamakura General Hospital, Kanagawa, Japan, 6 Harvard Medical School, Boston, MA Background: The PREDICTION study indicated that large plaque burden and low local endothelial shear stress (ESS) independently predict plaques that develop progressive enlargement and worsening lumen narrowing. The purpose of this study was to evaluate whether plaque components identiﬁed by intravascular ultrasound (IVUS) and iMAP provide additional predictive insight. Methods: The PREDICTION study was designed to assess plaque natural history in which 506 Japanese patients with an ACS underwent 3-vessel coronary angi- ography and radiofrequency IVUS to perform 3-dimensional coronary reconstruc- tion and plaque characterization by iMAP. At baseline (BL), we identiﬁed 250 discrete clinical relevant obstructions with a throat in the middle (minimal lumen area < 6 mm 2 ) and gradual narrowing upstream and downstream. ESS was assessed by computational ﬂuid dynamics. Tissue characteristics were assessed by iMAP and the percentages of constituents were averaged in consecutive 3-mm segments. Results: At 1-year follow-up (FU), percutaneous coronary intervention (PCI) for lesion progression or symptoms occurred in 31 BL obstructions (12%). At BL, the percentage of necrotic (%Ne; 17.8  13.4 vs 12.8  11%, p<0.05) and lipid (% Li; 13.1  9.3 vs 8.6  6.5%, <0.01) areas at the throat was signiﬁcantly higher in obstructions with PCI compared with those without a PCI. The %Ne (r¼0.61, p<0.01) and %Li (r¼0.63, p<0.01) were signiﬁcantly correlated with plaque burden. In multivariate analyses, BL large plaque burden (p<0.01) and low ESS (p¼0.06) were independent predictors of PCIs at FU, whereas BL %Ne (p¼0.28) or %Li (p¼0.79) or their combination (p¼0.42) were not found to have an additive predictive value. Conclusions: Tissue characterization of the % necrotic/lipidic plaque area did not confer independent prognostic value over that of plaque burden and ESS assessment for predicting adverse clinical events. Further studies are needed to elucidate whether tissue characterization with identiﬁcation of speciﬁc high-risk phenotypes (e.g. thin- cap ﬁbrous atheroma) could improve the predictive ability of plaque & hemodynamic assessment, especially in the higher risk western population. TCT-671 Relationship Between Plaque Morphologies And Clinical Presentation In The ADAPT-DES IVUS Substudy Liang Dong 1 , Gary S. Mintz 2 , Bernhard Witzenbichler 3 , D. Christopher Metzger 4 , Michael Rinaldi 5 , Ernest L. Mazzaferri 6 , Peter L. Duffy 7 , Giora Weisz 8 , Thomas Stuckey 9 , Bruce R. Brodie 10 , Ke Xu 11 , Gregg W. Stone 12 , Akiko Maehara 13 1 Cardiovascular Research Foundation/ 2nd Afﬁliated Hospital of Zhejiang University Medical School, New York, NY, 2 Cardiovascular Research Foundation, washington, DC, 3 Charité Campus Benjamin Franklin, Berlin, Germany, 4 Wellmont CVA Heart Institute, Kingsport, TN, 5 Associate Professor of Medicine, UNC Chapel Hill, Charlotte, NC, 6 Ohio State University, Dublin, OH, 7 Pinehurst Cardiology, Pinehurst, NC, 8 Columbia University, New York, United States, 9 Lebauer Cardiovascular Research Foundation, Greensboro, NC, 10 LeBauer CV Research Foundation, Greensboro, NC, 11 Cardiovascular Research Foundation, New York, NY, 12 Cardiovascular Research Foundation, NY, NY, 13 Cardiovascular Reserach Foundation and Columbia University Medical Center, New York, United States Background: ADAPT-DES study was a prospective multicenter, registry of 8,583 consecutive stable and unstable pts undergoing percutaneous coronary inter- vention (PCI) using a drug-eluting stent. A pre-speciﬁed grayscale and virtual histology (VH) intravascular ultrasound (IVUS) sub-study enrolled 2064 pts. Methods: Pre-PCI imaging of 773 pts identiﬁed 907 culprit lesions. The relationship between lesion morphology and clinical presentation was compared among pts with (1) ST-segment elevation myocardial infarction (STEMI), (2) non-STEMI (NSTEMI) or unstable angina (UA), and (3) stable CAD. Results: IVUS identiﬁed plaque ruptures in 52.1% of STEMI, 33.9% or NSTEMI/ UA, and 22.8% of stable CAD. In addition to more plaque ruptures, culprit lesions in STEMI pts had more thin-cap ﬁbroatheromas (TCFA); conversely, ﬁbroatheromas were more often calciﬁed (>10% dense calcium) with thick ﬁbrous caps (ThCFA) in stable CAD (Table). Minimum lumen area (MLA) was smaller with more plaque burden and positive remodeling in STEMI lesions compared to NSTEMI/UA and stable CAD. Overall (including all 3 groups), there were 304 lesions with plaque rupture. Lumen area at the rupture site measured 3.8 [3.6, 4.0] mm2 that was larger than the MLA in 78.3% and located proximally compared to the MLA site in 68.4%. Multivariate analysis showed that plaque burden at the MLA site (whether or not it was also the rupture site) was the only independent predictor for STEMI vs NSTEMI/UA or stable CAD presentation (Cut-off of plaque burden¼85%, AUC¼0.68). Conclusions: Culprit lesions causing STEMI have smaller lumen areas, greater plaque burden, and more plaque rupture or TCFA compared to NSTEMI/UA or stable presentation. Among lesions with plaque rupture, only plaque burden (85%) predicted STEMI presentation. Table. IVUS ﬁndings in culprit lesions between male and female pts in different age groups Variable Age< 65 years p-value Age  65 years p-value Male (N=379) Female (N=79) Male (N=320) Female (N=138) Plaque rupture 42% (159) 19% (15) 0.0007 30% (95) 25% (35) 0.35 Attenuated plaque 57% (215) 58% (46) 0.85 68% (219) 67% (92) 0.86 TCFA 54% (204) 39% (31) 0.04 53% (169) 48% (66) 0.39 MLA (mm 2 ) 2.9 [2.8, 3.0] 2.7 [2.5, 2.9] 0.08 2.9 [2.8, 3.0] 2.8 [2.6, 3.0] 0.69 Vessel area at MLA(mm 2 ) 14.4 [13.7, 15.0] 11.3 [10.3, 12.3] <0.001 13.9 [13.2, 14.6] 11.8 [11.0, 12.6] <0.001 Plaque burden at MLA (%) 76.5 [75.4, 77.7] 72.6 [69.7, 75.4] 0.01 76.4 [75.2, 77.6] 73.6 [71.8, 75.4] 0.01 (a)STEMI (b) NSTEMI/ UA (c) Stable CAD p-value (a) vs (b) p-value (b) vs (c) p-value (a) vs (c) Plaque rupture 52.1% (112) 33.9% (98) 22.8% (94) <0.0001 0.001 <0.0001 Any TCFA 62.3% (134) 51.2% (148) 45.6% (188) 0.01 0.15 <0.0001 TCFA at MLA 18.6% (40) 12.1% (35) 10.0% (41) 0.04 0.39 0.003 CA-ThCFA at MLA 10.7% (23) 19.0% (55) 24.8% (102) 0.008 0.08 <0.0001 MLA (mm 2 ) 2.6 [2.5, 2.7] 2.8 [2.7, 2.9] 3.0 [2.9, 3.2] 0.03 0.003 <0.0001 Plaque burden at MLA (%) 80 [78, 81] 76 [75, 77] 73 [72, 74] 0.0004 0.002 <0.0001 Remodeling Index 1.08 [1.02, 1.14] 1.01 [0.97, 1.05] 0.98 [0.94, 1.02] 0.05 0.25 0.004 www.jacctctabstracts2013.com TUESDAY, OCTOBER 29, 2013, 3:30 PM–5:30 PM JACC Vol 62/18/Suppl B j October 27–November 1, 2013 j TCT Abstracts/POSTER/Intravascular Imaging and Coronary Artery Disease B205 POSTERS