Effective anti-thrombotic therapy without stenting: intravascular optical coherence tomography-based management in plaque erosion (the EROSION study)

• Published in: European heart journal 2017-03, Vol.38 (11), p.792-800
• Main Authors: Jia, Haibo, Dai, Jiannan, Hou, Jingbo, Xing, Lei, Ma, Lijia, Liu, Huimin, Xu, Maoen, Yao, Yuan, Hu, Sining, Yamamoto, Erika, Lee, Hang, Zhang, Shaosong, Yu, Bo, Jang, Ik-Kyung
• Format: Article
• Language: English
• Subjects: Acute Coronary Syndrome - diagnostic imaging; Acute Coronary Syndrome - etiology; Coronary Angiography - methods; Coronary Stenosis - diagnostic imaging; Coronary Stenosis - drug therapy; Coronary Thrombosis - diagnostic imaging; Coronary Thrombosis - drug therapy; Female; Humans; Male; Middle Aged; Myocardial Ischemia - diagnostic imaging; Myocardial Ischemia - etiology; Observer Variation; Plaque, Atherosclerotic - diagnostic imaging; Plaque, Atherosclerotic - drug therapy; Prospective Studies; ST Elevation Myocardial Infarction - diagnostic imaging; ST Elevation Myocardial Infarction - etiology; Tomography, Optical Coherence; Treatment Outcome
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehw381

Plaque erosion, compared with plaque rupture, has distinctly different underlying pathology and therefore may merit tailored therapy. In this study, we aimed to assess whether patients with acute coronary syndrome (ACS) caused by plaque erosion might be stabilized by anti-thrombotic therapy without stent implantation. This was a single-centre, uncontrolled, prospective, proof-of concept study. Patients with ACS including ST-segment elevation myocardial infarction were prospectively enrolled. If needed, aspiration thrombectomy was performed. Patients diagnosed with plaque erosion by optical coherence tomography (OCT) and residual diameter stenosis 50% reduction of thrombus volume at 1 month compared with baseline. The secondary endpoint was a composite of cardiac death, recurrent ischaemia requiring revascularization, stroke, and major bleeding. Among 405 ACS patients with analysable OCT images, plaque erosion was identified in 103 (25.4%) patients. Sixty patients enrolled and 55 patients completed the 1-month follow-up. Forty-seven patients (47/60, 78.3%; 95% confidence interval: 65.8-87.9%) met the primary endpoint, and 22 patients had no visible thrombus at 1 month. Thrombus volume decreased from 3.7 (1.3, 10.9) mm3 to 0.2 (0.0, 2.0) mm3. Minimal flow area increased from 1.7 (1.4, 2.4) mm2 to 2.1 (1.5, 3.8) mm2. One patient died of gastrointestinal bleeding, and another patient required repeat percutaneous coronary intervention. The rest of the patients remained asymptomatic. For patients with ACS caused by plaque erosion, conservative treatment with anti-thrombotic therapy without stenting may be an option.