期刊
EUROPEAN HEART JOURNAL
卷 38, 期 11, 页码 792-800出版社
OXFORD UNIV PRESS
DOI: 10.1093/eurheartj/ehw381
关键词
Plaque erosion; Plaque rupture; Anti thrombotic therapy; Optical coherence tomography; Acute coronary syndrome
资金
- AstraZeneca [ISSBRIL0186]
- National Natural Science Foundation of China [81330033, 81200076, 81671763]
- Harbin Medical University Innovative Scientific Research Grant
Aims Plaque erosion, compared with plaque rupture, has distinctly different underlying pathology and therefore may merit tailored therapy. In this study, we aimed to assess whether patients with acute coronary syndrome (ACS) caused by plaque erosion might be stabilized by anti-thrombotic therapy without stent implantation Methods and results This was a single-centre, uncontrolled, prospective, proof-of concept study. Patients with ACS including ST-segment elevation myocardial infarction were prospectively enrolled. If needed, aspiration thrombectomy was performed. 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. 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 ischaemia requiring revascularization, stroke, and major bleeding. Among 405 ACS patients with analysable OCT images, plaque erosion was identified in 103 (25.4%) patients. Sixty patients enrolled and 55 patients completed the 1-month followup. 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) mm(3) to 0.2 (0.0, 2.0) mm(3). Minimal flow area increased from 1.7 (1.4, 2.4) mm(2) to 2.1 (1.5, 3.8) mm(2). One patient died of gastrointestinal bleeding, and another patient required repeat percutaneous coronary intervention. The rest of the patients remained asymptomatic Conclusion For patients with ACS caused by plaque erosion, conservative treatment with anti-thrombotic therapy without stenting may be an option.
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