Photo Credit: Czgur

In the PREVENT trial, researchers found that adding percutaneous coronary intervention to optimal medical treatment resulted in better patient outcomes.

Adding percutaneous coronary intervention (PCI) to optimal medical treatment (OMT) resulted in better outcomes for patients with high-risk vulnerable coronary plaques in the PREVENT trial. At 2 years, the statistically significant cumulative incidence of target vessel failure was 0.4% with and 3.4% without PCI.

The multicenter, randomized-controlled PREVENT trial (NCT02316886) compared OMT alone with OMT plus preventive PCI of vulnerable non-flow-limiting coronary plaques [1]. The 1,606 participants from research hospitals in South Korea, Japan, Taiwan, and New Zealand, were randomized 1:1 to PCI and OMT or OMT alone. Among the inclusion criteria were stenosis greater than 50% and a negative fractional flow reserve (FFR) greater than 0.80. The primary endpoint was a composite of death from cardiac causes, target vessel myocardial infarction, ischemic-driven target vessel revascularization, or hospitalization for unstable/progressive angina summarized as target vessel failure at 2 years. Seung-Jung Park, MD, from the University of Ulsan College of Medicine and the Asan Medical Center in South Korea, presented the results.

At 2 years, the results showed a cumulative incidence of target vessel failure in 0.4% of the OMT plus PCI arm, compared with 3.4% on OMT alone. This resulted in a significant hazard ratio of 0.11 (95% CI 0.03–0.36; P=0.0003). After a longer follow-up at 7 years, a consistent advantage of preventive PCI was seen with target vessel failure rates of 6.5% versus 9.4%, respectively (HR 0.54; 95% CI 0.33–0.87; P=0.0097).

Furthermore, any cause of death that was related to the patient, any myocardial infraction, or any repeat revascularization at 7 years was significantly reduced in the intervention group: HR 0.69 (95% CI 0.50–0.95; P=0.022). Among the individual primary outcome components, only ischemia-driven revascularization and hospitalization for angina were significantly in favor of the PCI group, other components showed no between-group difference. Also, no statistical differences were determined for secondary endpoints like bleeding events and stroke.

“Our key findings might provide a novel insight into the role of a preventive PCI on non-flow-limiting high-risk vulnerable plaques in the future,” concluded Dr Park.

Medical writing support was provided by Karin Drooff, MPH
Copyright ©2024 Medicom Medical Publishers