Angiographic Stenosis in Infarct-Related Artery Most are not severely stenosed
Additional Unstable Plaques Beyond the Culprit Lesion 27 patients with ACS. Angio + 3 vessel IVUS
Plaque Biology, Stenosis and Risk: The Paradox for PCI
Plaque Biology, Stenosis and Risk Stents are Not Enough ? Using current technology, Stenting alone cannot treat all high risk lesions Stenting alone does nothing to alter disease biology or natural history …….Statins ?
Why are Stents not Enough ? Stents treat lesions that are selected on luminal stenosis Plaque events are determined more by plaque biology, rather than stenosis Coronary disease is diffuse and progressive PCI at discrete sites does not alter disease burden or progression
Why Statins ? Statins directly alter CAD natural history through lipid lowering and other direct cellular effects Effects on mortality and morbidity in very large studies in primary and secondary prevention, including PCI High Dose, more potent newer statins can achieve plaque regression and stabilisation Stenting symptomatic stenoses combined with high-dose statin therapy is currently best CAD management strategy