title: Effective anti-thrombotic therapy without stenting: intravascular optical coherence tomography-based management in plaque erosion (the EROSION study).
abstract: OBJECTIVE
  Plaque erosion, compared with plaque rupture, has distinctly different underlying pathology and therefore may merit tailored therapy. In this study, we aimed to assess whether patients with acute coronary syndrome (ACS) caused by plaque erosion might be stabilized by anti-thrombotic therapy without stent implantation.
  
  
  RESULTS
  This was a single-centre, uncontrolled, prospective, proof-of concept study. Patients with ACS including ST-segment elevation myocardial infarction were prospectively enrolled. If needed, aspiration thrombectomy was performed. Patients diagnosed with plaque erosion by optical coherence tomography (OCT) and residual diameter stenosis <70% on coronary angiogram were treated with anti-thrombotic therapy without stenting. OCT was repeated at 1 month and thrombus volume was measured. The primary endpoint was >50% reduction of thrombus volume at 1 month compared with baseline. The secondary endpoint was a composite of cardiac death, recurrent ischaemia requiring revascularization, stroke, and major bleeding. Among 405 ACS patients with analysable OCT images, plaque erosion was identified in 103 (25.4%) patients. Sixty patients enrolled and 55 patients completed the 1-month follow-up. Forty-seven patients (47/60, 78.3%; 95% confidence interval: 65.8-87.9%) met the primary endpoint, and 22 patients had no visible thrombus at 1 month. Thrombus volume decreased from 3.7 (1.3, 10.9) mm3 to 0.2 (0.0, 2.0) mm3. Minimal flow area increased from 1.7 (1.4, 2.4) mm2 to 2.1 (1.5, 3.8) mm2. One patient died of gastrointestinal bleeding, and another patient required repeat percutaneous coronary intervention. The rest of the patients remained asymptomatic.
  
  
  CONCLUSIONS
  For patients with ACS caused by plaque erosion, conservative treatment with anti-thrombotic therapy without stenting may be an option.
authors: Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, Harbin, Heilongjiang 150086, P.R. China.
authors: Haibo
authors: H
authors: Jia
authors: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., GRB 800, Boston, MA 02114, USA.
authors: Jiannan
authors: J
authors: Dai
authors: Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, Harbin, Heilongjiang 150086, P.R. China.
authors: Jingbo
authors: J
authors: Hou
authors: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., GRB 800, Boston, MA 02114, USA.
authors: Lei
authors: L
authors: Xing
authors: Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, Harbin, Heilongjiang 150086, P.R. China.
authors: Lijia
authors: L
authors: Ma
authors: Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, Harbin, Heilongjiang 150086, P.R. China.
authors: Huimin
authors: H
authors: Liu
authors: Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, Harbin, Heilongjiang 150086, P.R. China.
authors: Maoen
authors: M
authors: Xu
authors: Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, Harbin, Heilongjiang 150086, P.R. China.
authors: Yuan
authors: Y
authors: Yao
authors: Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, Harbin, Heilongjiang 150086, P.R. China.
authors: Sining
authors: S
authors: Hu
authors: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., GRB 800, Boston, MA 02114, USA.
authors: Erika
authors: E
authors: Yamamoto
authors: Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, 50 Staniford St. Suite 560, Boston, MA 02114, USA.
authors: Hang
authors: H
authors: Lee
authors: Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, Harbin, Heilongjiang 150086, P.R. China.
authors: Shaosong
authors: S
authors: Zhang
authors: Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, Harbin, Heilongjiang 150086, P.R. China.
authors: Bo
authors: B
authors: Yu
authors: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., GRB 800, Boston, MA 02114, USA.
authors: Ik-Kyung
authors: IK
authors: Jang
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000209:etiology; D017023:Coronary Angiography / Q000379:methods; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000188:drug therapy; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000209:etiology; D015588:Observer Variation; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000188:drug therapy; D011446:Prospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome
keywords: Acute coronary syndrome; Anti-thrombotic therapy; Optical coherence tomography; Plaque erosion; Plaque rupture