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Xing L, Yamamoto E, Sugiyama T, Jia H, Ma L, Hu S, Wang C, Zhu Y, Li L, Xu M, Liu H, Bryniarski K, Hou J, Zhang S, Lee H, Yu B, Jang IK. EROSION Study (Effective Anti-Thrombotic Therapy Without Stenting: Intravascular Optical Coherence Tomography-Based Management in Plaque Erosion): A 1-Year Follow-Up Report. Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.117.005860. [PMID: 29246916 DOI: 10.1161/circinterventions.117.005860] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 10/29/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND The initial EROSION study (Effective Anti-Thrombotic Therapy Without Stenting: Intravascular Optical Coherence Tomography-Based Management in Plaque Erosion) demonstrated that patients with acute coronary syndrome caused by plaque erosion might be stabilized with aspirin and ticagrelor without stenting for ≤1 month. However, a long-term evaluation of outcomes is lacking. The aim of this study was to assess whether the initial benefit of noninterventional therapy for patients with acute coronary syndrome caused by plaque erosion is maintained for ≤1 year. METHODS AND RESULTS Among 53 patients who completed clinical follow-up, 49 underwent repeat optical coherence tomography imaging at 1 year. Median residual thrombus volume decreased significantly from 1 month to 1 year (0.3 mm3 (0.0-2.0 mm3] versus 0.1 mm3 [0.0-2.0 mm3]; P=0.001). Almost half of the patients (46.9%) had no residual thrombus at 1 year. Minimal effective flow area remained unchanged (2.1 mm2 [1.5-3.8 mm2] versus 2.1 mm2 [1.6-4.0 mm2]; P=0.152). Among 53 patients, 49 (92.5%) remained free from major adverse cardiovascular event for ≤1 year: 3 (5.7%) patients required revascularization because of exertional angina and 1 (1.9%) patient had gastrointestinal bleeding. CONCLUSIONS One-year follow-up optical coherence tomography demonstrated a further decrease in thrombus volume between 1-month and 1-year follow-up. A majority (92.5%) of patients with acute coronary syndrome caused by plaque erosion managed with aspirin and ticagrelor without stenting remained free of major adverse cardiovascular event for ≤1 year. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT02041650.
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Affiliation(s)
- Lei Xing
- From the Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratory of Myocardial Ischemia, China (L.X., H.J., L.M., S.H., C.W., Y.Z., L.L., M.X., H.L., J.H., S.Z., B.Y.); Cardiology Division (L.X., E.Y., T.S., K.B., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital, Harvard Medical School, Boston; and Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (I.-K.J.)
| | - Erika Yamamoto
- From the Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratory of Myocardial Ischemia, China (L.X., H.J., L.M., S.H., C.W., Y.Z., L.L., M.X., H.L., J.H., S.Z., B.Y.); Cardiology Division (L.X., E.Y., T.S., K.B., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital, Harvard Medical School, Boston; and Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (I.-K.J.)
| | - Tomoyo Sugiyama
- From the Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratory of Myocardial Ischemia, China (L.X., H.J., L.M., S.H., C.W., Y.Z., L.L., M.X., H.L., J.H., S.Z., B.Y.); Cardiology Division (L.X., E.Y., T.S., K.B., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital, Harvard Medical School, Boston; and Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (I.-K.J.)
| | - Haibo Jia
- From the Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratory of Myocardial Ischemia, China (L.X., H.J., L.M., S.H., C.W., Y.Z., L.L., M.X., H.L., J.H., S.Z., B.Y.); Cardiology Division (L.X., E.Y., T.S., K.B., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital, Harvard Medical School, Boston; and Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (I.-K.J.)
| | - Lijia Ma
- From the Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratory of Myocardial Ischemia, China (L.X., H.J., L.M., S.H., C.W., Y.Z., L.L., M.X., H.L., J.H., S.Z., B.Y.); Cardiology Division (L.X., E.Y., T.S., K.B., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital, Harvard Medical School, Boston; and Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (I.-K.J.)
| | - Sining Hu
- From the Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratory of Myocardial Ischemia, China (L.X., H.J., L.M., S.H., C.W., Y.Z., L.L., M.X., H.L., J.H., S.Z., B.Y.); Cardiology Division (L.X., E.Y., T.S., K.B., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital, Harvard Medical School, Boston; and Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (I.-K.J.)
| | - Chao Wang
- From the Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratory of Myocardial Ischemia, China (L.X., H.J., L.M., S.H., C.W., Y.Z., L.L., M.X., H.L., J.H., S.Z., B.Y.); Cardiology Division (L.X., E.Y., T.S., K.B., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital, Harvard Medical School, Boston; and Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (I.-K.J.)
| | - Yingchun Zhu
- From the Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratory of Myocardial Ischemia, China (L.X., H.J., L.M., S.H., C.W., Y.Z., L.L., M.X., H.L., J.H., S.Z., B.Y.); Cardiology Division (L.X., E.Y., T.S., K.B., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital, Harvard Medical School, Boston; and Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (I.-K.J.)
| | - Lulu Li
- From the Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratory of Myocardial Ischemia, China (L.X., H.J., L.M., S.H., C.W., Y.Z., L.L., M.X., H.L., J.H., S.Z., B.Y.); Cardiology Division (L.X., E.Y., T.S., K.B., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital, Harvard Medical School, Boston; and Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (I.-K.J.)
| | - Maoen Xu
- From the Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratory of Myocardial Ischemia, China (L.X., H.J., L.M., S.H., C.W., Y.Z., L.L., M.X., H.L., J.H., S.Z., B.Y.); Cardiology Division (L.X., E.Y., T.S., K.B., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital, Harvard Medical School, Boston; and Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (I.-K.J.)
| | - Huimin Liu
- From the Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratory of Myocardial Ischemia, China (L.X., H.J., L.M., S.H., C.W., Y.Z., L.L., M.X., H.L., J.H., S.Z., B.Y.); Cardiology Division (L.X., E.Y., T.S., K.B., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital, Harvard Medical School, Boston; and Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (I.-K.J.)
| | - Krzysztof Bryniarski
- From the Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratory of Myocardial Ischemia, China (L.X., H.J., L.M., S.H., C.W., Y.Z., L.L., M.X., H.L., J.H., S.Z., B.Y.); Cardiology Division (L.X., E.Y., T.S., K.B., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital, Harvard Medical School, Boston; and Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (I.-K.J.)
| | - Jingbo Hou
- From the Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratory of Myocardial Ischemia, China (L.X., H.J., L.M., S.H., C.W., Y.Z., L.L., M.X., H.L., J.H., S.Z., B.Y.); Cardiology Division (L.X., E.Y., T.S., K.B., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital, Harvard Medical School, Boston; and Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (I.-K.J.)
| | - Shaosong Zhang
- From the Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratory of Myocardial Ischemia, China (L.X., H.J., L.M., S.H., C.W., Y.Z., L.L., M.X., H.L., J.H., S.Z., B.Y.); Cardiology Division (L.X., E.Y., T.S., K.B., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital, Harvard Medical School, Boston; and Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (I.-K.J.)
| | - Hang Lee
- From the Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratory of Myocardial Ischemia, China (L.X., H.J., L.M., S.H., C.W., Y.Z., L.L., M.X., H.L., J.H., S.Z., B.Y.); Cardiology Division (L.X., E.Y., T.S., K.B., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital, Harvard Medical School, Boston; and Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (I.-K.J.)
| | - Bo Yu
- From the Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratory of Myocardial Ischemia, China (L.X., H.J., L.M., S.H., C.W., Y.Z., L.L., M.X., H.L., J.H., S.Z., B.Y.); Cardiology Division (L.X., E.Y., T.S., K.B., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital, Harvard Medical School, Boston; and Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (I.-K.J.).
| | - Ik-Kyung Jang
- From the Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratory of Myocardial Ischemia, China (L.X., H.J., L.M., S.H., C.W., Y.Z., L.L., M.X., H.L., J.H., S.Z., B.Y.); Cardiology Division (L.X., E.Y., T.S., K.B., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital, Harvard Medical School, Boston; and Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (I.-K.J.).
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Hong SJ, Ahn CM, Kim BK, Ko YG, Hur SH, Yu CW, Lee SJ, Choi CU, Kim JS, Yoon JH, Hong YJ, Choi JW, Choi SH, Jang Y, Lim DS. Prospective randomized comparison of clinical and angiographic outcomes between everolimus-eluting vs. zotarolimus-eluting stents for treatment of coronary restenosis in drug-eluting stents: intravascular ultrasound volumetric analysis (RESTENT-ISR trial). Eur Heart J 2016; 37:3409-3418. [PMID: 27634828 DOI: 10.1093/eurheartj/ehw389] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 06/24/2016] [Accepted: 08/15/2016] [Indexed: 12/21/2022] Open
Abstract
AIMS At present no proven standard treatment for drug-eluting stent (DES) restenosis is available, and the efficacy and safety of everolimus-eluting stent (EES) and zotarolimus-eluting stent (ZES) for DES restenosis are limited. The purpose of this prospective, randomized 9-month intracoronary ultrasound (IVUS) and 3-year clinical follow-up study was to compare the effects of EESs and ZESs on neointima volume and major adverse cardiovascular events (MACEs) such as death, myocardial infarction (MI), target lesion revascularization (TLR) and stent thrombosis in DES restenosis patients. METHODS AND RESULTS Patients were eligible for this study if they were between 40 and 75 years old with in-stent restenosis >50% by quantitative coronary angiographic analysis in DES or within 5 mm of the stent edges with signs of ischaemia. Eligible patients (n = 304, 146 women and 158 men) were randomly assigned to receive either EES (158 patients) or ZES (146 patients). The primary endpoint of the study was to compare neointima volume between the EES and ZES groups at the 9-month follow-up IVUS. MACEs, including death, non-fatal MI, stent thrombosis and the need for repeated TLR within 3 years, were noted. The 9-month angiographic and IVUS follow-up showed no significant differences in late lumen loss (0.40 ± 0.56 vs. 0.45 ± 0.61 mm, P = 0.57, respectively) and neointima volume (0.51 ± 0.48 vs. 0.56 ± 0.54 mm3/1 mm, P = 0.47, respectively) in the EES and the ZES groups. Composite MACEs such as death, MI, stent thrombosis and TLR during 3-year follow-up were comparable between the two groups [15.8% (n = 25) in the EES group and 22.6% (n = 33) in the ZES group, P = 0.276], independent of de novo DES type, sex, age, body mass index, presence of diabetes, hypertension and dyslipidaemia. CONCLUSIONS Patients with first- and second-generation DES restenosis, both EES and ZES implantation were effective and safe in reducing neointima volume and late loss with a comparable rate of MACEs independent of cardiovascular risk factors.
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Affiliation(s)
- Soon Jun Hong
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, 126-1, 5ka, Anam-dong, Sungbuk-ku, Seoul 136-705, Korea
| | - Chul Min Ahn
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, 126-1, 5ka, Anam-dong, Sungbuk-ku, Seoul 136-705, Korea.,Severance Cardiovascular Hospital, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea
| | - Byeong-Keuk Kim
- Severance Cardiovascular Hospital, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea
| | - Young-Guk Ko
- Severance Cardiovascular Hospital, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea
| | - Seung-Ho Hur
- Keimyung University Dongsan Medical Center, 56 Dalseong-Ro, Jung-Gu, Daegu 700-712 Korea
| | - Cheol Woong Yu
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, 126-1, 5ka, Anam-dong, Sungbuk-ku, Seoul 136-705, Korea
| | - Seung-Jin Lee
- Soonchunhyang University Medical Center, 23-20, Byeongmyeong-dong, Dongnam-gu, Cheonan, Chungcheongnam-do 31151, Korea
| | - Cheol Ung Choi
- Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul 08308, Korea
| | - Je Sang Kim
- Sejong General Hospital, Sosabon-dong, Sosa-gu, Bucheon-si, Gyeonggi-do 14754, Korea
| | - Jung-Han Yoon
- Yonsei University Wonju College of Medicine, Wonju Christian Hospital, 20 Ilsan-ro, Wonju, Gangwon-do, Wonju 220-701, Korea
| | - Young Joon Hong
- Chonnam National University Hospital, 77 Yongbong-ro, Buk-gu, Gwangju 500-757, Korea
| | - Jae-Woong Choi
- Eulji General Hospital, 68 Hangeulbiseok-Ro, Nowon-Gu, Seoul 01830, Korea
| | - Seung-Hyuk Choi
- Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Yangsoo Jang
- Severance Cardiovascular Hospital, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea
| | - Do-Sun Lim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, 126-1, 5ka, Anam-dong, Sungbuk-ku, Seoul 136-705, Korea
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