Patients with vulnerable plaque identified by means of intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS) are at a significantly increased risk of adverse cardiovascular events.
Revascularization of these vulnerable lesions could prevent clinical events. That is the theory behind prophylactic angioplasty, which still needs to be proven in clinical practice.
The PROSPECT ABSORB study, nested within the PROSPECT II study, analyzed the natural history of patients with vulnerable plaque treated with a now-discontinued bioresorbable vascular scaffold.
This was the first randomized study comparing prophylactic revascularization vs. optimal medical treatment in functionally non-significant lesions with high plaque volume.
PROSPECT II enrolled 898 infarcted patients with or without ST-segment elevation who underwent successful angioplasty on the culprit vessel, and who were assessed through NIRS and IVUS on the rest of their coronary tree.
PROSPECT ABSORB enrolled 182 patients presenting more than one non-culprit lesion with a plaque level of at least 65% confirmed by IVUS. These patients were randomized to ABSORB revascularization vs. medical treatment.
The combined primary endpoint of cardiac death, vessel-related infarction, or clinically-driven revascularization occurred in 4.3% of patients in the ABSORB group vs. 4.5% in the medical treatment group (p = 0.96).
After 2 years of follow-up, researchers observed that the minimum lumen area of the lesions targeted by IVUS was significantly larger in the revascularization group compared to the medical treatment group. The lumen area of medically-treated plaque was stable, with no observed progression.
The difference in clinical events was based on severe angina episodes, a soft spot that emphasizes the controversial nature of prophylactic angioplasty.
Reference: Stone GW et al. JAm Coll Cardiol. 2020; Epub ahead of print y presentado en forma virtual en el TCT 2020.
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