CLINICAL
NEWS JOURNAL WRAP
Kim Eagle, MD, and the editors of ACC.org, present relevant
articles taken from various journals.
This study, for the first time, demonstrates that patients with ACS
caused by erosion may benefit from a
tailored therapy with anti-thrombotic
medications,” said lead investigator
Ik-Kyung Jang, MD, PhD, from Harvard Medical School, Massachusetts
General Hospital in Boston. “If we
can identify ACS patients with erosion without an invasive procedure,
those patients may be triaged to a
conservative therapy pathway instead
of invasive catheterization and stent
implantation.”
“Due to the relatively small sample
size, this study shou ld be replicated
in a larger trial before this is considered for standard therapy,” said
Kim A. Eagle, MD, editor in chief
of ACC.org.
REFERENCE
Jia H, Dai J, Hou J, et al. Eur Heart J.
2016;doi:10.1093/eurheartj/ehw381
EROSION: Some ACS Patients
May be Able to Avoid Stents
More than 25% of patients with acute
coronary syndromes (ACS) who are
normally treated with stents may
be able to forgo this procedure and
receive anti-thrombotic medications
only, according to results of the EROSION pilot study presented Aug. 30
during ESC Congress 2016 in Rome,
and simultaneously published in
the European Heart Journal.
The study used optical coherence
tomography (OCT) to differentiate
plaque erosion from plaque rupture
among 405 ACS patients presenting
at the emergency department and
undergoing coronary angiography.
Plaque erosion was identified as the
underlying pathology in 103 (25.4%)
patients, of whom 60 had a residual
diameter stenosis of less than 70% on
angiogram, Thrombolysis In Myocardial Infarction (TIMI) flow grade of
three, and were stable without symp-
18
CardioSource WorldNews: Interventions
toms. These patients received antithrombotic medications alone without stent placement and were treated
with dual antiplatelet therapy (DAPT)
(aspirin and ticagrelor). Additionally,
63.6% of these patients received a
glycoprotein IIb/IIIa inhibitor.
At one month follow-up, 47 of the
60 patients (78.3%) met the primary
endpoint of a more than 50% reduction in the size of their clot. Twenty
two patients had no visible clot at all.
Overall, clot volume decreased from
3.7 to 0.2 mm3 and minimal flow
area increased from 1.7 to 2.1 mm2.
One patient died of gastrointestinal
bleeding while on DAPT and another one had no improvement in the
stenotic artery at 1 month, with the
decision to undergo PCI.
“Currently all patients with ACS
are uniformly treated with stenting
regardless of underlying pathology.
LAAO Devices vs.
Medical Therapy
in AF
New research published in Heart
attempts to determine the relative
safety and efficacy of left atrial appendage occlusion (LAAO) devices
as compared to medical therapy in
patients with nonvalvular atrial fibrillation (AF).
Researchers performed a network
meta-analysis using 19 randomized
controlled trials that either compared
warfarin to placebo, antiplatelet
therapy, or one of the novel oral anticoagulants (NOACs). Two randomized trials examining the efficacy
and safety of LAA occlusion using
the Watchman device were also
included. Of the 87,831 patients in
the studies, 36,645 were assigned to
warfarin, 43,314 to NOACs, 6,215
to antiplatelet therapy, 925 to placebo, and 732 were included in the
LAA occlusion trials.
“This study
demonstrates,
for the first time,
that patients
with ACS caused
by erosion
may benefit
from a tailored
therapy with
anti-thrombotic
medications.”
— Ik-Kyung Jang, MD, PhD
On direct comparison, there was
a mortality benefit with NOACs as
compared to warfarin; there was no
difference in this outcome between
NOACs and LAAO. Warfarin was
superior to both antiplatelet therapy
and placebo. With respect to thromboembolism, NOAC treatment was
superior to warfarin, whereas LAAO
was equivalent. On indirect comparison, LAAO was associated with a
lower risk of mortality as compared
to placebo or antiplatelet therapy, but
September/October 2016