The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Predictors of Non-Stenting Strategy for Acute Coronary Syndrome Caused by Plaque Erosion: 4-Year Outcomes of the EROSION Study

DOI: 10.4244/EIJ-D-20-00299

1. Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China. 
2. The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
3. Cardiovascular Research Foundation, New York, 10019 NY, USA
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Aims: To test whether a non-stenting anti-thrombotic strategy was still effective at 4-year follow-up in patients enrolled in the EROSION study and to explore potential predictors of long-term prognosis.

Methods and results: Out of 55 patients who completed 1-month follow-up, 52 patients finished 4-year follow-up. The median duration was 4.8 years (4.2 - 5.8 years). The majority of patients remained free from events, and all patients were free from hard endpoints (death, myocardial infarction, stroke, bypass surgery, or heart failure). Only 1 patient had gastrointestinal bleeding, and 11 patients underwent elective target lesion revascularization (TLR). Patients in the non-TLR group had more optical coherence tomography (OCT) thrombus reduction from baseline to 1 month; 95% patients in the non-TLR group versus 45% in the TLR group (p=0.001) met the primary endpoint (thrombus volume reduction >50%). Consistent with the OCT findings, angiographic results showed that the TLR group had less improvement in diameter stenosis (p=0.014) at 1 month compared with non-TLR group.

Conclusions: Four-year follow-up findings reconfirmed the safety of an anti-thrombotic therapy without stenting for erosion-caused acute coronary syndrome. Patients with better response to anti-thrombotic therapy in the first month were less likely to require stent implantation during the next four years.

 

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