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Potent platelet inhibition with peri-procedural tirofiban may attenuate progression of atherosclerosis in patients with acute coronary syndromes

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Abstract

Organization of platelet-rich thrombus at the site of plaque disruption may contribute to rapid progression of atherosclerosis. This study was conducted to investigate if potent platelet inhibition therapy in patients with acute coronary syndromes (ACS) mitigates plaque progression. Patients enrolled in the EROSION study who presented with ACS caused by plaque erosion and underwent serial imaging of the culprit lesion by optical coherence tomography at baseline, 1 month, and 1 year were included. Among 49 patients, 32 (65.3%) patients were treated with glycoprotein IIb/IIIa inhibitor (GPI) in addition to aspirin and ticagrelor. The increase in area stenosis from baseline to 1-year follow-up was significantly smaller in patients treated with GPI, compared to those without GPI therapy (4.8% [− 1.6 to 10.9] vs. 9.6% [4.0 to 21.3], p = 0.031). The cohort was divided into 2 groups based on culprit lesion phenotype at 1 year: Group A, new layer formation at 1-year that was not present at baseline (n = 18); Group B, no new layer formation (n = 31). A new layer was less frequently found at 1 year in patients treated with GPI than in those without GPI (25.0% vs. 58.8%, p = 0.019). Group A, compared to Group B, was associated with a greater increase in area stenosis (19.0 ± 16.4% vs. 3.7 ± 7.1%; p < 0.001). Potent platelet inhibition with GPI in patients with ACS caused by plaque erosion was associated with lower incidence of new layer formation and less plaque progression.

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Acknowledgements

Dr. Jang’s research was supported by the Allan Gray Fellowship Fund in Cardiology and by Mr. and Mrs. Michael and Kathryn Park. They had no role in the design or conduct of this research.

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Authors and Affiliations

  1. Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 800, Boston, MA, 02114, USA

    Akihiro Nakajima, Makoto Araki, Osamu Kurihara & Ik-Kyung Jang

  2. Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Hang Lee

  3. Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan

    Sunao Nakamura

  4. Kyung Hee University, Seoul, Korea

    Ik-Kyung Jang

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  1. Akihiro Nakajima
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  2. Makoto Araki
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  6. Ik-Kyung Jang
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Correspondence to Ik-Kyung Jang.

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Dr. Jang has received educational grant support from Abbott Vascular and a consulting fee from Svelte Medical Systems Inc. All other authors have no relationships relevant to the contents of this paper to disclose.

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Nakajima, A., Araki, M., Kurihara, O. et al. Potent platelet inhibition with peri-procedural tirofiban may attenuate progression of atherosclerosis in patients with acute coronary syndromes. J Thromb Thrombolysis 53, 241–248 (2022). https://doi.org/10.1007/s11239-021-02500-9

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