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ESC: Medical Therapy Adequate for Plaque Erosion

— Pilot study suggests stenting not needed in uncomplicated cases

Ƶ MedicalToday

ROME -- Antithrombotic medications successfully treated plaque erosion without stenting in a proof-of-concept study reported here.

With 1 month of antithrombotic therapy after finding plaque erosion on optical coherence tomography (OCT), patients' median thrombus volume plummeted from 3.7 mm3 to 0.2 mm3 (P<0.001). In addition, minimal flow area rose from 1.7 mm2 to 2.1 mm2 (P=0.002), according to , of Boston's Massachusetts General Hospital.

Minimum lumen diameter increased from 1.35 mm to 1.54 mm (P<0.001). In addition, 78.3% of patients had their thrombus volume slashed in half or more; another 36.7% had no residual thrombus on follow-up.

Jang presented the results of the so-called EROSION study at the annual meeting of the European Society of Cardiology; they were also published simultaneously in the .

"Randomized trials will be needed to reproduce this pilot data and to further evaluate the long-term outcome of this new treatment strategy in patients with acute coronary syndrome [ACS] caused by plaque erosion," Jang said.

However, the minimum lumen diameter achieved after therapy (1.54 mm) was theoretically still flow-limiting in a non-infarcted area, session discussant , of Erasmus University in Rotterdam, The Netherlands, pointed out.

What's more, he added, 66% of patients did not have their minimum lumen area rise above 1.95 mm2, a threshold for positive fractional flow reserve.

EROSION included 60 patients (out of 405 screened) who presented with an ACS at the emergency department of a single center in China and had plaque erosion identified on OCT without plaque rupture or major stenosis. Those with the lowest left ventricular ejection fractions (less than 30%) were excluded, as well as those who could not tolerate the antithrombotics.

One patient died of gastrointestinal bleeding; another had target lesion revascularization following no angiographic improvement with the antithrombotics.

Before invasive imaging, patients got aspirin 300 mg, ticagrelor 180 mg, and unfractionated heparin 100 IU/kg. The antithrombotics continued after catheterization, including dual antiplatelet therapy with aspirin and ticagrelor thereafter.

Most patients (83.6%) also received manual aspiration thrombectomy as part of their treatment.

Serruys noted the use of the glycoprotein IIb/IIIa inhibitor tirofiban (Aggrastat) in two-thirds of participants involved -- another limitation of Jang's non-randomized, unblinded trial.

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    Nicole Lou is a reporter for Ƶ, where she covers cardiology news and other developments in medicine.

Disclosures

EROSION was supported by AstraZeneca.

Jang declared receiving a fellowship grant from St. Jude Medical.

Serruys reported relationships with Abbott, AstraZeneca, Biotronik, Cardialysis B.V., GLG Research, Medtronic, Sinomedical, Societe Europa Digital & Publishing, Stentys, Svelte, Volcano, Q3 Medical, and St. Jude Medical.

Primary Source

European Society of Cardiology

Jang I, et al "Effective anti-thrombotic therapy without stenting: Intravascular OCT-based management in plaque erosion (the EROSION study)" ESC 2016.

Secondary Source

European Society of Cardiology

Serruys PW "Can patients with acute coronary syndromes caused by plaque erosion be treated with anti-thrombotic therapy without stenting?" ESC 2016.