Predictors of non-stenting strategy for acute coronary syndrome caused by plaque erosion: four-year outcomes of the EROSION study

He, Luping; Qin, Yuhan; Xu, Yiyue; Hu, Sining; Wang, Yini; Zeng, Ming; Feng, Xue; Liu, Qi; Ikramullah, Syed; Demuyakor, Abigail; Zhao, Chen; Chen, Xi; Li, Zhaoyue; Meng, Wei; Xu, Maoen; Liu, Huimin; Ma, Lei; Dai, Jihong; Liu, Xing; Hou, Yu; Hou, Jingbo; Jia, Haibo; Mintz, Gary S.; Yu, Bo

doi:10.4244/eij-d-20-00299

Cited by 37 publications

(35 citation statements)

References 19 publications

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“… 30 In addition, anti-thrombotic therapy, instead of stent implantation, is largely safe and effective for many patients with PE. 3–5 Moreover, criminal plaque morphology is important for the prognosis of ACS patients, as previous studies indicate that patients with PR have a higher risk of major adverse cardiac events and complications than those with PE. 15 Taken together, these data suggest that non-invasive prediction of plaque morphology using serum biomarkers may be an important improvement for the clinical management of these diseases, allowing for personalized treatment strategies and improved prognosis for patients with ACS.…”

Section: Discussionmentioning

confidence: 99%

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TNF-α is a Novel Biomarker for Predicting Plaque Rupture in Patients with ST-Segment Elevation Myocardial Infarction

Luo¹,

Zhao²,

Wang³

et al. 2022

JIR

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Background and Aims Patients with plaque rupture (PR) present with different cardiovascular risks, clinical strategies, and outcomes from those with plaque erosion (PE). However, there are lack of noninvasive biomarkers to distinguish PE from PR. Methods A prospective analysis of 382 patients with ST-segment elevation myocardial infarction (STEMI) was conducted. Of these patients, 262 and 120 presented with PR and PE, respectively. An additional 83 patients diagnosed with stable angina pectoris were enrolled as control group. Peripheral blood monocytes were collected pre-percutaneous coronary intervention and used to evaluate the mRNA expression of IL-4 , IL-10 , IL-1β , and TNF-α in all patients. Results STEMI patients had higher IL-4 , IL-10 , IL-1β , and TNF-α expression than the control patients. The mRNA levels of IL-4 , IL-1β , and TNF-α were significantly higher in PR patients than PE; however, no significant difference was observed in IL-10 between PE and PR. The areas under the receiver-operating characteristic curves for IL-4 , IL-1β , and TNF-α for PR versus PE were 0.685, 0.747, and 0.895, respectively. At the cut-off value of 2.52, TNF-α demonstrated a sensitivity of 70.61% and specificity of 93.33% for discriminating PR from PE patients. When added to the model of established clinical risk factors, TNF-α significantly improved the predictive accuracy of PR. Multivariable logistic regression analysis indicated that TNF-α mRNA level was independently associated with PR (odds ratio, 3.09; 95% confidence interval, 2.29–4.16; p < 0.001). Conclusion The inflammatory response of peripheral blood mononuclear cells in patients with PR was higher than that in patients with PE. TNF-α may be a potential biomarker for predicting PR that could facilitate risk stratification and management in STEMI patients.

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Section: Discussionmentioning

confidence: 99%

“…Furthermore, it was reported that the risk of major adverse cardiac events and complications was higher in patients with PR than in patients with PE. 3–6 Thus, it is important to differentiate between PE and PR to establish a personalized treatment strategy and improve the prognosis of patients with ACS.…”

Section: Introductionmentioning

confidence: 99%

TNF-α is a Novel Biomarker for Predicting Plaque Rupture in Patients with ST-Segment Elevation Myocardial Infarction

Luo¹,

Zhao²,

Wang³

et al. 2022

JIR

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“…One patient had to discontinue DAPT because of gastrointestinal bleeding ( 43 ). In the final 4-year report, 21% of the patients underwent target lesion revascularization (TLR) ( 44 ). The EROSION study provides compelling data supporting the efficacy of DAPT with aspirin and ticagrelor in eroded plaques.…”

Section: Current Evidencementioning

confidence: 99%

The Role of Antiplatelet Therapy in Patients With MINOCA

Ortega‐Paz

Galli

Capodanno

et al. 2022

Front. Cardiovasc. Med.

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Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous group of clinical entities characterized by the common clinical evidence of myocardial infarction (MI) with non-obstructive coronary arteries on coronary angiography and without an overt cause for the MI. Platelets play a cornerstone role in the pathophysiology of MI with obstructive coronary arteries. Accordingly, antiplatelet therapy is recommended for treating patients with MI and obstructive coronary disease. However, the role of platelets in the pathophysiology of MINOCA patients is not fully defined, questioning the role of antiplatelet therapy in this setting. In this review, we will assess the role of antiplatelet therapy in MINOCA with a focus on the pathophysiology, therapeutic targets, current evidence, and future directions according to its different etiologies.

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“…Several small clinical trials have shown the feasibility of this treatment strategy in short-and long-term outcomes. 122,123 Large-scale randomized trials are needed to replicate these pilot study results and to further confirm long-term outcomes of this new treatment option in patients with ACS caused by PE.…”

Section: Invasive Treatmentmentioning

confidence: 99%

Vulnerable Plaque in Patients with Acute Coronary Syndrome: Identification, Importance, and Management

Sakamoto¹,

Cornelissen²,

Sato³

et al. 2022

US Cardiology Review

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MI is a leading cause of morbidity and mortality worldwide. Coronary artery thrombosis is the final pathologic feature of the most cases of acute MI primarily caused by atherosclerotic coronary artery disease. The concept of vulnerable plaque has evolved over the years but originated from early pioneering work unveiling the crucial role of plaque rupture and subsequent coronary thrombosis as the dominant cause of MI. Along with systemic cardiovascular risk factors, developments of intravascular and non-invasive imaging modalities have allowed us to identify coronary plaques thought to be at high risk for rupture. However, morphological features alone may only be one of many factors which promote plaque progression. The current vulnerable-plaque-oriented approaches to accomplish personalized risk assessment and treatment have significant room for improvement. In this review, the authors discuss recent advances in the understanding of vulnerable plaque and its management strategy from pathology and clinical perspectives.

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Predictors of non-stenting strategy for acute coronary syndrome caused by plaque erosion: four-year outcomes of the EROSION study

Cited by 37 publications

References 19 publications

TNF-α is a Novel Biomarker for Predicting Plaque Rupture in Patients with ST-Segment Elevation Myocardial Infarction

TNF-α is a Novel Biomarker for Predicting Plaque Rupture in Patients with ST-Segment Elevation Myocardial Infarction

The Role of Antiplatelet Therapy in Patients With MINOCA

Vulnerable Plaque in Patients with Acute Coronary Syndrome: Identification, Importance, and Management

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