Why is this study important?

Acute coronary syndromes are commonly caused by the rupture of vulnerable plaque (VP). Pharmacologic management is considered standard therapy for stabilizing plaque vulnerability. The safety and effectiveness of focal preventive percutaneous coronary intervention (PCI) of non-flow limiting VP are unknown.

This study is the first randomized trial of preventive percutaneous coronary intervention (PCI) for the treatment of non-flow limiting vulnerable plaques defined by intracoronary imaging in patients with coronary artery disease that has been powered for improved clinical outcomes.

What question was this study supposed to answer?

The PREVENT trial was designed to compare preventive PCI plus optimal medical therapy (OMT) with OMT alone in patients with functionally nonsignificant high-risk vulnerable plaques. Patients with stenosis greater than 50% but fractional flow reserve (FFR) negative were randomized after VP was defined by imaging to OMT alone versus preventative PCI and OMT.

What did the study show?

Preventive PCI plus OMT resulted in a lower incidence of major adverse cardiac events compared with OMT alone in patients with non-flow-limiting vulnerable plaques during long-term follow-up up to seven years.

Target vessel failure (TVF) at two years was 3.4% in the OMT group and 0.4% in the preventative PCI/OMT group (p=0.0003). At seven-year follow-up, TVF in the OMT group was 9.4% versus 6.5% in the preventative PCI/OMT (p=0.001).