[Safety and effectiveness of pharmacologic versus mechanical stabilization of borderline coronary lesions in patients with acute coronary syndromes].
BACKGROUND
Borderline coronary lesions are responsible for about 80% of acute coronary syndromes (ACS). Statins have been found to improve long-term prognosis in patients with coronary artery disease due to plaque stabilization. There are no reports on the frequency of new events caused by progression of borderline lesions in patients with (ACS). Percutaneous coronary intervention (PCI) as a method of mechanical stabilization of borderline coronary lesions could be an alternative to pharmacological approach.


OBJECTIVE
To compare the efficacy of pharmacological and mechanical stabilization of borderline plaques (DS = 40-60%) in patients with ACS.


METHODS
Patients with ACS and angiographically documented borderline lesions, related to the ACS or located in other coronary arteries were enrolled. Patients were randomized to receive pharmacotherapy without intervention or to undergo PCI. The primary end-point was rate of target lesion revascularization with PCI or coronary bypass grafting (CABG) caused by progression of coronary stenosis or in-stent restenosis/thrombosis. The secondary endpoint was incidence of major adverse cardiac events (MACE) at long-term follow-up (death, ST segment elevation acute coronary syndrome--STEACS and non-ST segment elevation acute coronary syndrome-- NSTEACS).


RESULTS
Pharmacological stabilization was used in 50 patients, mean age 56.7 +/- 9.14 years, whereas 44 patients, mean age 57.2 +/- 10.4 years, underwent plaque stabilization with PCI. At follow-up (mean 521 days) target lesion revascularization was performed in 3 patients, previously receiving pharmacotherapy, due to progression of coronary stenosis, and in 3 patients, after prior PCI, due to in-stent restenosis (7% vs. 8%, p = NS). The rate of MACE in both groups was also similar (6% vs. 5%, p = NS).


CONCLUSIONS
There were no differences between mechanical and pharmacological stabilization of borderline coronary lesions in patients with acute coronary syndromes.
Legutko
Jacek
J
II Klinika Kardiologii Collegium Medicum, Uniwersytetu Jagiellońskiego w Krakowie. jaceklegutko@yahoo.com
Dudek
Dariusz
D
Chyrchel
Michał
M
Rzeszutko
Lukasz
L
Bartuś
Stanisław
S
Heba
Grzegorz
G
Dubiel
Jacek S
JS
D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D023903:Coronary Restenosis / Q000517:prevention & control; D023921:Coronary Stenosis / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D003328:Coronary Thrombosis / Q000517:prevention & control; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016896:Treatment Outcome
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors