Significance of prior percutaneous revascularisation in patients with acute coronary syndromes: insights from the prospective PROSPECT registry

Abstract

Prior PCI was noted in over 10% of patients with ACS and was associated with higher mortality and morbidity, independent of other comorbidities. Prior PCI should be considered a high-risk feature when evaluating ACS patients.

Coronary Atherosclerotic Vulnerable Plaque: Current Perspectives

“…Finally, the number of nonculprit, asymptomatic, potentially type-switching plaques may be such, especially in cases of high atherosclerotic burden 5 that renders, in combination with the above, all efforts at localized "vulnerability-guided" treatment, without the ability to accurately assess implications futile, if not dangerous. 126 Despite the above, the apparent shortcomings of the vulnerable plaque hypothesis are not attributed to it having been superseded by our ability to prevent, diagnose, and treat coronary atherosclerosis. Rather, current widespread interpretation and focus on imaging and still-frame structural features have significantly diverged from the original concept, with regard to which we have only covered half the necessary path.…”

“…More specifically, flow alterations following a silent event or even a successful coronary intervention could inevitably, and currently unpredictably, alter the course of even distant lesions. Finally, the number of nonculprit, asymptomatic, potentially type‐switching plaques may be such, especially in cases of high atherosclerotic burden that renders, in combination with the above, all efforts at localized “vulnerability‐guided” treatment, without the ability to accurately assess implications futile, if not dangerous …”