STEMI caused by plaque erosion can be managed effectively without stenting: EROSION study
Republic of Korea: A recent study assessing the initial benefit of noninterventional therapy for patients with acute coronary syndrome caused by plaque erosion found that optical coherence tomography (OCT) demonstrated a further decrease in thrombus volume between a 1-month and 1-year follow-up. A majority (92.5%) of the patients remained free from major adverse cardiovascular events (MACE) for ≤1 year.
"92.5% of patients with the acute coronary syndrome (ACS) caused by plaque erosion managed with aspirin and ticagrelor without stenting remained free of the major adverse cardiovascular event for ≤1 year," wrote the authors.
In simpler words, results from the EROSION III Study showed that plaque erosion, not a rupture, could be left unstented, but the need for dual antiplatelet therapy likely persists. The study was published in the journal Circulation: Cardiovascular Interventions.
The initial EROSION study (Effective Anti-Thrombotic Therapy Without Stenting: Intravascular Optical Coherence Tomography–Based Management in Plaque Erosion) had shown that patients with acute coronary syndrome caused by plaque erosion might be stabilized with aspirin and ticagrelor without stenting for ≤1 month. However, there is a lack of long-term evaluation of outcomes. In the study, Lei Xing, Kyung Hee University Hospital, Seoul, Republic of Korea, and colleagues aimed to assess whether the initial benefit of noninterventional therapy for patients with acute coronary syndrome caused by plaque erosion is maintained for ≤1 year.
Among 53 patients who completed clinical follow-up, 49 underwent repeat optical coherence tomography imaging at 1 year.
The study revealed the following findings:
- Median residual thrombus volume decreased significantly from 1 month to 1 year (0.3 mm3 versus 0.1 mm3).
- Almost half of the patients (46.9%) had no residual thrombus at 1 year.
- Minimal effective flow area remained unchanged (2.1 mm2 versus 2.1 mm2 [1.6–4.0 mm2]).
- Among 53 patients, 92.5% remained free from major adverse cardiovascular events for ≤1 year: 5.7% of patients required revascularization because of exertional angina and 1.9% of patients had gastrointestinal bleeding.
"This study suggests the possibility of individualized therapy for patients with acute coronary syndromes," concluded the authors.
Reference:
"EROSION Study (Effective Anti-Thrombotic Therapy Without Stenting: Intravascular Optical Coherence Tomography–Based Management in Plaque Erosion): A 1-Year Follow-Up Report," is published in the Circulation: Cardiovascular Interventions.
DOI: https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.117.005860
