Videos | Cath Lab | October 17, 2020

VIDEO: Pre-emptive Treatment of Vulnerable Plaques With Bioresorbable Stents

Gregg Stone, M.D., presents the results of the PROSPECT ABSORB Trial in a press conference at the 2020 ranscatheter Cardiovascular Therapeutics (TCT) Connect virtual meeting. 

The PROSPECT ABSORB Trial was a randomized evaluation of vulnerable plaques using the Abbott Absorb fully bioresorbable stent. The hypothesis of the trial  was to treat lesions prior to plaque ruptured to avoid heart attacks, rather than treating them after plaque rupture when a potential infarct and permanent heart damage is caused. Patients were randomized to percutaneous coronary intervention (PCI) using an Absorb bioresobable vascular scaffold (BVS) stents vs. guideline directed medical therapy (GDMT).

This is the first study that proactively identifies and preemptively treats vulnerable plaques. 

Lesion related MACE events 4 years showed medical therapy alone resulted in 10.7 percent events and the BVS treat patients were 4.3 percent. Stone said the favorable BVS MACE rates warrants a larger, adequately powered randomized trial to determine if PCI treatment of focal vulnerable plaques improves patient outcomes. 

The study looked at periprocedural anticoagulation during percutaneous corona intervention in AMI patients. There has been conflicting results reported between several trials looking at which drug is best for anticoagulation during cath procedures.

This study pooled data from 8 studies that included more than 27,000 patients. The data included both STEMI and NSTEMI patients.

The pool analysis found STEMI patients, bivalirudin was associated with reductions mortality, serious bleeding and NACE events, despite higher rates of myocardial infarction  (MI) and stent thrombosis compared with heparin. The mortality benefit of bivalirudin was pronounced in patients with a post-PCI bivalirudin infusion to mitigate MI and stent thrombosis risks. 

In NSTEMI patients, bivalirudin was associated with a reduction in 30 day serious bleeding events, but similar rates of mortality, MI and stent thrombosis compared to heparin.

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