What is the aim of this study?
Assess whether patients with acute coronary syndrome (ACS)
caused by plaque erosion might be stabilized by anti-thrombotic therapy without stent implantation.
Give main points of the methods used.
- Single-centre, uncontrolled, prospective, proof-of concept study.
2.Patients with ACS including ST-segment
elevation myocardial infarction were prospectively enrolled.
3.Patients diagnosed with plaque erosion by optical coherence tomography (OCT) and residual diameter stenosis <70% on coronary angiogram were treated with anti-thrombotic therapy without stenting.
- OCT was repeated at
1 month and thrombus volume was measured.
5.Sixty patients enrolled and 55 patients completed the 1-month followup.
What is the end point of the study?
- The primary endpoint was >50% reduction of thrombus volume at 1 month compared with baseline.
- The secondary endpoint was a composite of cardiac death, recurrent ischaemiarequiring revascularization, stroke, and major bleeding.
What is the result?
- Among 405 ACS patients with analysable OCT images, plaque erosion was identified in 103 (25.4%) patients.
- Forty-seven patients (47/60, 78.3%; 95% confidence interval: 65.8–87.9%) met the primary endpoint, and 22
patients had no visible thrombus at 1 month. - Thrombus volume decreased from 3.7 (1.3, 10.9) mm3 to 0.2 (0.0, 2.0)
mm3. - Minimal flow area increased from 1.7 (1.4, 2.4) mm2 to 2.1 (1.5, 3.8) mm2.
5.
Any deaths?
One patient died of gastrointestinalbleeding, and another patient required repeat percutaneous coronary intervention. The rest of the patients remained
asymptomatic.
Whats is the conclusion?
For patients with ACS caused by plaque erosion, conservative treatment with anti-thrombotic therapy without
stenting may be an option.
