EROSION TRIAL- Treating MI without Stents

Patients were treated with unfractionated heparin or low molecular weight heparin for 3 days. Dual anti-platelet therapy (aspirin 100mg/day + ticagrelor 90mg, BID) was continued. Those without recurrent ischemia were discharged on day 5. OCT was repeated at 1 month and thrombus volume was measured.

Among 405 ACS patients with analyzable OCT images, plaque erosion was identified in 103 individuals (25.4%). Sixty of these patients enrolled and 55 completed the 1-month follow-up (4 were found to have >70% stenosis by the core laboratory and 1 patient died).

The majority of patients (96.7%) had STEMI and manual thrombectomy was done in 84% of patients. Glycoprotein IIb/IIIa inhibitors were used in 63.3%.

Forty-seven patients (47/60, 78.3%) met the primary endpoint of a >50% reduction in thrombus volume at 1 month compared to baseline. In 22 patients, no thrombus was visible. Overall, thrombus volume decreased by 94.2%, from 3.7 mm3 to 0.2 mm3. Minimal flow area increased from 1.7 mm2 to 2.1 mm2.

One patient died of gastrointestinal bleeding, and another patient required repeat percutaneous coronary intervention for angiographic stenosis but without symptoms or evidence of ischemia. The rest of the patients remained asymptomatic.

The investigators concluded that plaque erosion was the underlying pathology in one-quarter of patients with ACS. For these patients, conservative treatment with anti-thrombotic therapy with aspirin and ticagrelor but without stenting may be an option. Further trials will be needed to reproduce this pilot data.

References