Erosion Study Main Points

Question 1

What is the aim of this study?

Answer 1

Assess whether patients with acute coronary syndrome (ACS)

caused by plaque erosion might be stabilized by anti-thrombotic therapy without stent implantation.

Question 2

Give main points of the methods used.

Answer 2

1. Single-centre, uncontrolled, prospective, proof-of concept study.

2.Patients with ACS including ST-segment
elevation myocardial infarction were prospectively enrolled.

3.Patients diagnosed with plaque erosion by optical coherence tomography (OCT) and residual diameter stenosis <70% on coronary angiogram were treated with anti-thrombotic therapy without stenting.

4. OCT was repeated at
   1 month and thrombus volume was measured.

5.Sixty patients enrolled and 55 patients completed the 1-month followup.

Question 3

What is the end point of the study?

Answer 3

1. The primary endpoint was >50% reduction of thrombus volume at 1 month compared with baseline.
2. The secondary endpoint was a composite of cardiac death, recurrent ischaemiarequiring revascularization, stroke, and major bleeding.

Question 4

What is the result?

Answer 4

1. Among 405 ACS patients with analysable OCT images, plaque erosion was identified in 103 (25.4%) patients.
2. 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.
3. Thrombus volume decreased from 3.7 (1.3, 10.9) mm3 to 0.2 (0.0, 2.0)
   mm3.
4. Minimal flow area increased from 1.7 (1.4, 2.4) mm2 to 2.1 (1.5, 3.8) mm2.

5.

Question 5

Any deaths?

Answer 5

One patient died of gastrointestinalbleeding, and another patient required repeat percutaneous coronary intervention. The rest of the patients remained
asymptomatic.

Question 6

Whats is the conclusion?

Answer 6

For patients with ACS caused by plaque erosion, conservative treatment with anti-thrombotic therapy without
stenting may be an option.