Are we ripe for preventive percutaneous coronary interventions?

Abstract

INTRODUCTION Preventive percutaneous coronary intervention (PCI) refers to the treatment of high-risk plaque before the occurrence of any adverse events. Typically, the decision to perform preventive treatment is made when the expected event rate of the underlying condition outweighs the potential short- and long-term complications of the procedure. This approach is also applicable to the treatment of coronary disease. In recent years, advances in understanding atherosclerotic plaque progression and identifying high-risk plaques, along with technological progress in coronary devices, have shifted the balance between the risks of the underlying condition and those of percutaneous treatment. THE CONCEPT OF VULNERABLE PLAQUE The understanding of high-risk coronary plaques, also known as vulnerable plaques, has evolved over the years. Initially, a vulnerable plaque was often considered an angiographically nonsignificant stenosis that was prone to rupture and cause acute coronary syndrome.1 The PROSPECT study was the first landmark trial to focus on the natural history of vulnerable plaques, assessed using intravascular ultrasound with virtual histology.2 This trial was the first to define specific criteria for plaque vulnerability, notably thin-cap fibroatheroma (TCFA). TCFA is characterized by a lipid-rich plaque with a necrotic core, separated from the vessel lumen by a thin fibrotic cap. The trial also identified 2...