Percutaneous coronary intervention for non-obstructive vulnerable plaques

Vulnerable coronary plaques are susceptible to rupturing, leading to potentially devastating thrombotic complications and exposing individuals to a high risk of future major adverse cardiac events. 1 Bom MJ van der Heijden DJ Kedhi E et al. Early detection and treatment of the vulnerable coronary plaque: can we prevent acute coronary syndromes?. Circ Cardiovasc Imaging. 2017; 10e005973 Crossref PubMed Scopus (65) Google Scholar , 2 Kumric M Borovac JA Martinovic D Ticinovic Kurir T Bozic J Circulating biomarkers reflecting destabilization mechanisms of coronary artery plaques: are we looking for the impossible?. Biomolecules. 2021; 11: 881 Crossref PubMed Scopus (15) Google Scholar , 3 Stone GW Maehara A Mintz GS The reality of vulnerable plaque detection. JACC Cardiovasc Imaging. 2011; 4: 902-904 Crossref PubMed Scopus (20) Google Scholar Vulnerable plaques typically consist of a large necrotic core and a thin fibrous cap with a thickness less than 65 μm, commonly referred to as thin-cap fibroatheroma. Acute rupture of vulnerable plaques was shown to be the underlying culprit in 73% of all thrombotic coronary events resulting in fatality, 4 Falk E Nakano M Bentzon JF Finn AV Virmani R Update on acute coronary syndromes: the pathologists' view. Eur Heart J. 2013; 34: 719-728 Crossref PubMed Scopus (802) Google Scholar suggesting a great mechanistic relevance of vulnerable plaques. Additionally, the use of invasive intravascular imaging methods, such as optical coherence tomography, has shown that plaque rupture is the primary cause of acute coronary syndrome. 5 Aguirre AD Arbab-Zadeh A Soeda T Fuster V Jang I-K Optical coherence tomography of plaque vulnerability and rupture: JACC focus seminar part 1/3. J Am Coll Cardiol. 2021; 78: 1257-1265 Crossref PubMed Scopus (28) Google Scholar Considering the exceedingly high global burden of ischaemic heart disease, 6 Bergmark BA Mathenge N Merlini PA Lawrence-Wright MB Giugliano RP Acute coronary syndromes. Lancet. 2022; 399: 1347-1358 Summary Full Text Full Text PDF PubMed Scopus (112) Google Scholar efforts to prevent and mitigate its development and subsequent complications are crucial for public health improvements. Preventive percutaneous coronary intervention versus optimal medical therapy alone for the treatment of vulnerable atherosclerotic coronary plaques (PREVENT): a multicentre, open-label, randomised controlled trialIn patients with non-flow-limiting vulnerable coronary plaques, preventive percutaneous coronary intervention reduced major adverse cardiac events arising from high-risk vulnerable plaques, compared with optimal medical therapy alone. Given that PREVENT is the first large trial to show the potential effect of the focal treatment for vulnerable plaques, these findings support consideration to expand indications for percutaneous coronary intervention to include non-flow-limiting, high-risk vulnerable plaques. Full-Text PDF