Early Win for Preemptive Stents: trials ongoing related to preventive PCI on vulnerable plaques

Researchers have long sought to prevent heart attacks caused by vulnerable coronary plaques – fatty buildups in the heart’s arteries that have the potential to rupture and cause blood clots. A new study presented at the American College of Cardiology (ACC) meeting offers hope that a preventive approach using stents may hold the key.

Promising Results

The PREVENT study involved over 1,600 patients with vulnerable plaques treated either with preventive percutaneous coronary intervention (PCI) – stenting – or medical therapy alone. After two years, the PCI group experienced significantly lower rates of target vessel failure, a composite of heart attack, revascularization, or hospitalization for unstable angina (0.4% vs 3.4%). This benefit persisted for up to seven years, suggesting long-term effectiveness.

A Shift in Paradigm?

The study challenges current guidelines that reserve PCI for obstructive or acute lesions. “I think it is brave to challenge the paradigm that medical therapy alone is sufficient to treat vulnerable plaques,” said ACC session discussant Dr. Dawn Abbott.

Unanswered Questions

While the findings are promising, experts caution that more research is needed. “I think it’s unrealistic for every interventionalist to use multiple imaging modalities,” said Dr. Marc Bonaca, highlighting the challenge of accurately identifying vulnerable plaques. Others emphasized the need for ongoing trials to further clarify the role of preventive PCI.

Next Steps

Several ongoing trials, including COMBINE-INTERVENE and VULNERABLE, are expected to provide more insights into this promising approach. Researchers hope to determine the optimal criteria for identifying vulnerable plaques, the ideal timing for intervention, and the long-term safety and efficacy of preventive PCI.

Implications for Patients

While the PREVENT study results are encouraging, they do not yet change clinical practice. Patients with vulnerable plaques should continue to follow their doctor’s recommendations for lifestyle changes, medications, and regular monitoring. However, the study opens the door to potential future treatments that could significantly reduce the risk of heart attacks.