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%.
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; p = 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.
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.
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