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  • Stone, Gregg W.Cardiovascular Research Foundation, New York,Icahn School of Medicine at Mount Sinai (author)

Percutaneous Coronary Intervention for Vulnerable Coronary Atherosclerotic Plaque

  • Article/chapterEnglish2020

Publisher, publication year, extent ...

  • Elsevier BV,2020
  • 13 s.

Numbers

  • LIBRIS-ID:oai:lup.lub.lu.se:a98d802c-6034-4075-8231-1cddcc8abe03
  • https://lup.lub.lu.se/record/a98d802c-6034-4075-8231-1cddcc8abe03URI
  • https://doi.org/10.1016/j.jacc.2020.09.547DOI
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-430266URI
  • http://kipublications.ki.se/Default.aspx?queryparsed=id:145418869URI

Supplementary language notes

  • Language:English
  • Summary in:English

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  • Subject category:art swepub-publicationtype
  • Subject category:ref swepub-contenttype

Notes

  • Background: Acute coronary syndromes most commonly arise from thrombosis of lipid-rich coronary atheromas that have large plaque burden despite angiographically appearing mild. Objectives: This study sought to examine the outcomes of percutaneous coronary intervention (PCI) of non–flow-limiting vulnerable plaques. Methods: Three-vessel imaging was performed with a combination intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS) catheter after successful PCI of all flow-limiting coronary lesions in 898 patients presenting with myocardial infarction (MI). Patients with an angiographically nonobstructive stenosis not intended for PCI but with IVUS plaque burden of ≥65% were randomized to treatment of the lesion with a bioresorbable vascular scaffold (BVS) plus guideline-directed medical therapy (GDMT) versus GDMT alone. The primary powered effectiveness endpoint was the IVUS-derived minimum lumen area (MLA) at protocol-driven 25-month follow-up. The primary (nonpowered) safety endpoint was randomized target lesion failure (cardiac death, target vessel–related MI, or clinically driven target lesion revascularization) at 24 months. The secondary (nonpowered) clinical effectiveness endpoint was randomized lesion–related major adverse cardiac events (cardiac death, MI, unstable angina, or progressive angina) at latest follow-up. Results: A total of 182 patients were randomized (93 BVS, 89 GDMT alone) at 15 centers. The median angiographic diameter stenosis of the randomized lesions was 41.6%; by near-infrared spectroscopy–IVUS, the median plaque burden was 73.7%, the median MLA was 2.9 mm2, and the median maximum lipid plaque content was 33.4%. Angiographic follow-up at 25 months was completed in 167 patients (91.8%), and the median clinical follow-up was 4.1 years. The follow-up MLA in BVS-treated lesions was 6.9 ± 2.6 mm2 compared with 3.0 ± 1.0 mm2 in GDMT alone–treated lesions (least square means difference: 3.9 mm2; 95% confidence interval: 3.3 to 4.5; p < 0.0001). Target lesion failure at 24 months occurred in similar rates of BVS-treated and GDMT alone–treated patients (4.3% vs. 4.5%; p = 0.96). Randomized lesion–related major adverse cardiac events occurred in 4.3% of BVS-treated patients versus 10.7% of GDMT alone–treated patients (odds ratio: 0.38; 95% confidence interval: 0.11 to 1.28; p = 0.12). Conclusions: PCI of angiographically mild lesions with large plaque burden was safe, substantially enlarged the follow-up MLA, and was associated with favorable long-term clinical outcomes, warranting the performance of an adequately powered randomized trial. (PROSPECT ABSORB [Providing Regional Observations to Study Predictors of Events in the Coronary Tree II Combined with a Randomized, Controlled, Intervention Trial]; NCT02171065)

Subject headings and genre

Added entries (persons, corporate bodies, meetings, titles ...)

  • Maehara, AkikoCardiovascular Research Foundation, New York,New York Presbyterian Hospital/Columbia University Medical Center (author)
  • Ali, Ziad A.Cardiovascular Research Foundation, New York,New York Presbyterian Hospital/Columbia University Medical Center (author)
  • Held, Claes,1956-Uppsala universitet,Uppsala University,Uppsala University Hospital,Uppsala kliniska forskningscentrum (UCR),Kardiologi(Swepub:uu)clahe947 (author)
  • Matsumura, MitsuakiCardiovascular Research Foundation, New York (author)
  • Kjøller-Hansen, LarsZealand University Hospital (author)
  • Bøtker, Hans ErikAarhus University Hospital (author)
  • Maeng, MichaelAarhus University Hospital (author)
  • Engstrøm, ThomasUniversity of Copenhagen(Swepub:lu)th4331en (author)
  • Wiseth, RuneSt. Olav’s University Hospital (author)
  • Persson, JonasKarolinska Institutet,Karolinska Institute,Danderyd Hospital (author)
  • Trovik, ThorUniversity Hospital of North Norway (author)
  • Jensen, UlfStockholm South General Hospital (author)
  • James, Stefan,1964-Uppsala universitet,Uppsala University,Uppsala University Hospital,Uppsala kliniska forskningscentrum (UCR),Kardiologi(Swepub:uu)stjam367 (author)
  • Mintz, Gary S.Cardiovascular Research Foundation, New York (author)
  • Dressler, OvidiuCardiovascular Research Foundation, New York (author)
  • Crowley, AaronCardiovascular Research Foundation, New York (author)
  • Ben-Yehuda, OriUniversity of California, San Diego,Cardiovascular Research Foundation, New York (author)
  • Erlinge, DavidLund University,Lunds universitet,Molekylär kardiologi,Forskargrupper vid Lunds universitet,Molecular Cardiology,Lund University Research Groups(Swepub:lu)kard-der (author)
  • Cardiovascular Research Foundation, New YorkIcahn School of Medicine at Mount Sinai (creator_code:org_t)
  • PROSPECT ABSORB Investigators

Related titles

  • In:Journal of the American College of Cardiology: Elsevier BV76:20, s. 2289-23010735-10971558-3597

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