Preventive percutaneous coronary intervention versus optimal medical therapy alone for the treatment of vulnerable...

Area of Science:

• Cardiology
• Interventional Cardiology
• Preventive Cardiology

Background:

• Vulnerable plaques, often non-flow-limiting, are a primary cause of acute coronary syndrome and sudden cardiac death.
• The efficacy of preventive percutaneous coronary intervention (PCI) for these specific plaques remains largely unestablished.
• Assessing preventive PCI's role in high-risk, non-flow-limiting vulnerable plaques is crucial for improving patient outcomes.

Purpose of the Study:

• To evaluate the effectiveness of preventive percutaneous coronary intervention (PCI) versus optimal medical therapy (OMT) alone.
• To determine if PCI of non-flow-limiting vulnerable plaques reduces adverse cardiac events.
• To compare clinical outcomes between PCI plus OMT and OMT alone in a high-risk patient cohort.

Main Methods:

• A multicentre, open-label, randomised controlled trial (PREVENT) involving 1606 patients.
• Patients with non-flow-limiting vulnerable plaques (FFR >0.80) were randomized to PCI + OMT or OMT alone.
• The primary outcome was a composite of cardiac death, target-vessel MI, revascularisation, or unstable angina hospitalization at 2 years.

Main Results:

• Preventive PCI significantly reduced the primary composite outcome compared to OMT alone (0.4% vs 3.4%, p=0.0003).
• No significant difference was observed in serious adverse events, including death or myocardial infarction, between the groups at 2 years.
• The positive effect of preventive PCI was consistent across all components of the primary composite outcome.

Conclusions:

• Preventive percutaneous coronary intervention is effective in reducing major adverse cardiac events in patients with non-flow-limiting vulnerable plaques.
• These findings support the consideration of expanding PCI indications to include high-risk, non-flow-limiting vulnerable plaques.
• The PREVENT trial provides the first large-scale evidence for focal treatment of vulnerable plaques.