To stent or not to stent? Favourable results for preventive PCI in vulnerable atherosclerotic plaques

Adding percutaneous coronary intervention (PCI) to optimal medical treatment (OMT) resulted in better outcomes for patients with high-risk vulnerable coronary plaques in the PREVENT trial. At 2 years, the statistically significant cumulative incidence of target vessel failure was 0.4% with and 3.4% without PCI.  

The multicentre, randomised-controlled PREVENT trial (NCT02316886) compared OMT alone with OMT plus preventive PCI of vulnerable non-flow-limiting coronary plaques [1]. The 1,606 participants from research hospitals in South Korea, Japan, Taiwan, and New Zealand) were randomised 1:1 to PCI and OMT or OMT alone. Among the inclusion criteria were stenosis >50% and a negative fractional flow reserve (FFR) of ≥0.80. The primary endpoint was a composite of death from cardiac causes, target vessel myocardial infarction, ischaemic-driven target vessel revascularisation, or hospitalisation for unstable/progressive angina summarised as target vessel failure at 2 years. Prof. Seung-Jung Park (University of Ulsan College of Medicine; Asan Medical Center, South Korea) presented the results.

At 2 years, the results showed a cumulative incidence of target vessel failure in 0.4% of the OMT plus PCI arm, compared with 3.4% on OMT alone. This resulted in a significant hazard ratio of 0.11 (95% CI 0.03–0.36; P=0.0003). After a longer follow-up at 7 years, a consistent advantage of preventive PCI was seen with target vessel failure rates of 6.5% versus 9.4%, respectively (HR 0.54; 95% CI 0.33–0.87; P=0.0097).

Furthermore, the patient-oriented composite of any-cause death, any MI, or any repeat revascularisation at  7 years was significantly reduced in the intervention group: HR 0.69 (95% CI 0.50–0.95; P=0.022). Among the individual primary outcome components, only ischaemia-driven revascularisation and hospitalisation for angina were significantly in favour of the PCI group, other components showed no between-group difference. Also, no statistical differences were determined for secondary endpoints like bleeding events and stroke.

“Our key findings might provide a novel insight into the role of a preventive PCI on non-flow-limiting high-risk vulnerable plaques in the future,” concluded Prof. Park.

1. 
   
   1. Park SJ. Preventive PCI or medical therapy alone for atherosclerotic coronary vulnerable plaques. LB5, Session 412, ACC 2024 Scientific Session, 6–8 April, Atlanta, USA.
   2. Park SJ, et al. Lancet; April 8. DOI: 10.1016/S0140-6736(24)00413-6.

Medical writing support was provided by Karin Drooff, MPH
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Posted on 11 April, 2024