Plaque Erosion with No Stenting in Acute Coronary Syndrome: Are There Event Predictors to Avoid This Strategy?

 Event predictors in patients with plaque erosion and no stenting.


A third of all acute coronary syndrome (ACS) cases are caused by plaque erosion. In the initial EROSION study, it was shown that patients with plaque erosion (as evidenced by OCT, with stenosis <70%, TIMI III flow, and asymptomatic) were stabilized without stent implantation (no stenting strategy), with antiplatelet therapy using aspirin and ticagrelor. In turn, the 4-year follow-up of this study showed an incidence of major adverse cardiovascular events (MACE) of 23.1%.

Erosión de placa con “no stenting” en el síndrome coronario agudo: ¿Existen predictores de eventos para evitar esta estrategia?

The aim of the study by Yin Y. et al. was to compare the predictors of adverse events with this type of strategy in a retrospective cohort from one center and the historical cohort of the EROSION study (232 patients in total). Patients were divided into two groups according to the occurrence or not of MACE. Patients with ST-elevation, non-ST-elevation, and unstable angina (pretreated with aspirin, ticagrelor, and unfractionated heparin) were included.

Of the 232 ACS patients included, 21.6% had experienced a MACE event (composite outcome of cardiac death, recurrent acute myocardial infarction, ischemia-guided revascularization, rehospitalization for angina, major bleeding, or stroke) at the 2.9-year follow-up. Patients with MACE were older (55.7 vs. 51 years; p = 0.004) and with higher prevalence of diabetes (18% vs. 8.8%; p = 0.063). When analyzing OCT data, those patients with events had lower prevalence of presence of a fibrous plaque (6% vs. 22%, p = 0.010), higher thrombotic burden (24.4% vs. 20.4%; p = 0.010), smaller minimal luminal area (2.3 vs. 2.9, p = 0.001), and higher stenosis area percentage (SA%) (72.2% vs. 64.2%, p ≤ 0.001).

Read also: Uncomplicated Type B Aortic Dissection.

With a multivariate analysis, researchers observed that age (hazard ratio [HR]: 1.035; 95% confidence interval [CI]: 1.005-1.065; = 0.021), SA% (HR: 1.043; 95% CI: 1.015-1.071; p = 0.003) and thrombotic burden (HR: 1.026; 95% CI: 1.001-1.053; p = 0.044) were event predictors. In turn, they analyzed with an ROC curve the best cutoff points for the definition of events, which were age >60 years, SA% ≥63.5%, and thrombotic burden ≥18.5%. The MACE rate with these three predictors present was 57.7%.

Conclusions

Patients with ACS selected for the no stenting strategy had a MACE rate of 21.6%, with the predictors for clinical outcomes being age >60 years, SA% >63.5%, and thrombotic burden >18.5%. Therefore, these characteristics should be taken into account before deciding to omit stenting.

Dr. Omar Tupayachi

Dr. Omar Tupayachi.
Member of the editorial board of SOLACI.org.

Original Title: Predictors of Adverse Prognosis in Patients With Acute Coronary Syndrome Caused by Plaque Erosion With a Nonstent Strategy.

Reference: Yin Y, Lei F, Fang C, Jiang S, Xu X, Sun S, Pei X, Jia R, Tang C, Peng C, Li S, Li L, Wang Y, Yu H, Dai J, Yu B. Predictors of Adverse Prognosis in Patients With Acute Coronary Syndrome Caused by Plaque Erosion With a Nonstent Strategy. J Am Heart Assoc. 2022 Dec 20;11(24):e026414. doi: 10.1161/JAHA.122.026414. Epub 2022 Dec 19. PMID: 36533592; PMCID: PMC9798785.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

More articles by this author

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 – ECLIPSE: Randomized Study of Orbital Atherectomy vs Conventional PCI in Severely Calcified Lesions

Coronary calcification is associated with stent under-expansion and increased risk of both early and late adverse events. Atherectomy is an essential tool for uncrossable...

TCT 2024 | Use of Drug-Coated Balloons for Side Branch Treatment in Provisional Stenting

In some cases, treating coronary bifurcations with provisional stenting requires side branch stenting, which may lead to suboptimal outcomes. Drug-coated balloons (DCBs) have emerged...

TCT 2024 | Use of Artificial Intelligence for Patients with Suspected Coronary Artery Disease

The current approach to chest pain mainly focuses on symptom characteristics, conducting functional tests for ischemia assessment. However, several randomized clinical trials have shown...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 | TRISCEND II

This randomized study included 400 patients; 267 were treated with EVOQUE valve and 133 with optimal medical treatment (OMT). After one-year follow-up, there were no...

TCT 2024 – ACCESS-TAVI: Comparing Percutaneous Access Closure Strategies After TAVI

Vascular access complications following transcatheter aortic valve implantation (TAVI) remain common. However, few studies compare vascular access closure methods.  Based on the CHOICE-CLOSURE and MASH...