Preventive percutaneous coronary intervention may effectively reduce major adverse cardiovascular events in patients with high-risk atherosclerotic coronary plaques.
Percutaneous coronary intervention is a common treatment for patients with myocardial ischemia and involves the placement of a stent into a blocked artery.
In the PREVENT trial, presented by Park et al at the American College of Cardiology (ACC) Annual Scientific Session 2024 and simultaneously published in The Lancet, researchers randomly assigned 1,606 patients with high-risk atherosclerotic coronary plaques that were not severe enough to be symptomatic or cause ischemia to undergo either preventive percutaneous coronary intervention in combination with optimal medical therapy or optimal medical therapy alone. They sought to better understand whether the procedure had the potential to stabilize high-risk plaques.
After a follow-up of 2 years, the patients who underwent percutaneous coronary intervention and medical therapy had an 89% lower risk of experiencing the composite primary endpoint of heart attacks in the target vessel, revascularization because of ischemia in the target vessel, hospitalization for unstable or progressive chest pain, and cardiac death compared with the patients who received medical therapy alone. The researchers reported that 0.4% (n = 3) of the patients in the percutaneous coronary intervention plus medical therapy group vs 3.4% (n = 27) of the patients in the medical therapy alone group experienced the composite primary endpoint. After a median follow-up of 4.4 years, these findings persisted, demonstrating a significantly lower risk of experiencing the composite primary endpoint as well as each component of the endpoint among patients who received percutaneous coronary intervention and medical therapy.
The researchers plan to conduct further studies to better elucidate which patients may benefit most from preventive percutaneous coronary intervention.
“These findings demonstrate that the focal treatment of high-risk vulnerable plaques may improve patient prognosis beyond optimal medical therapy alone,” concluded lead study author Seung-Jung Park, MD, Professor in the Division of Cardiology at the Asan Medical Center at the University of Ulsan College of Medicine in Seoul, South Korea.
