The PREVENT trial suggests that preventive percutaneous coronary intervention (PCI) for non-flow-limiting vulnerable plaques significantly reduces major adverse cardiac events compared to optimal medical therapy (OMT) alone.
Advanced intracoronary imaging (IVUS, OCT, NIRS) has reached a diagnostic maturity that allows for the precise identification of high-risk plaque features like thin fibrous caps and large lipid cores.
Despite clinical benefits in composite endpoints, the lack of significant reduction in hard mortality data and the open-label nature of current trials fuel an ongoing debate regarding the ‘default’ status of this intervention.
Residual cardiovascular risk remains high under OMT, but the rapid evolution of lipid-lowering and anti-inflammatory drugs presents a moving target for the incremental value of mechanical stabilization.
