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Recent retrospective investigations have suggested that optical coherence tomography (OCT) enables the diagnosis of underlying acute coronary syndrome (ACS) causes such as plaque rupture, plaque erosion, and calcified nodule. The relationships of these etiologies with clinical outcomes, and the clinical utility of OCT-guided primary percutaneous coronary intervention (PCI) are not systematically studied in real-world ACS treatment settings. The TACTICS registry is an investigator-initiated, prospective, multicenter, observational study to be conducted at 21 hospitals in Japan. A total of 700 patients with ACS (symptom onset within 24 h) undergoing OCT-guided primary PCI will be enrolled. The primary endpoint of the study is to identify the underlying causes of ACS using OCT-defined morphological assessment of the culprit lesion. The key secondary clinical endpoints are hazard ratios of the composite of cardiovascular death, non-fatal myocardial infarction, heart failure, or ischemia-driven revascularization in patients with underlying etiologies at the 12- and 24-month follow-ups. The feasibility of OCT-guided primary PCI for ACS will be assessed by the achievement rates of optimal post-procedural results and safety endpoints. The TACTICS registry will provide an overview of the underlying causes of ACS using OCT, and will reveal any difference in clinical outcomes depending on the underlying causes. The registry will also inform on the feasibility of OCT-guided primary PCI for patients with ACS. The TACTICS (Tokyo, Kanagawa, Chiba, Shizuoka, and Ibaraki active OCT applications for ACS) registry. ACS, acute coronary syndrome; OCT, optical coherence tomography; PCI, percutaneous coronary intervention. [Display omitted] • TACTICS is an investigator-initiated prospective multicenter observational study. • Optical coherence tomography (OCT)-guided primary percutaneous coronary intervention (PCI) will be performed. • The primary endpoint is to identify the underlying causes of acute coronary syndrome (ACS). • Clinical outcomes and feasibility of OCT-guided PCI will be clarified. [ABSTRACT FROM AUTHOR]

• This research aimed to investigate the impact of plaque change in patients with acute coronary syndrome. • Patients who achieved plaque regression by intravascular ultrasound had lower rates of clinical events. • Plaque regression with on-treatment low levels of low-density lipoprotein cholesterol was an only better predictor of major adverse cardiac and cerebrovascular events. The use of serial intravascular ultrasound (IVUS) for coronary atherosclerosis has offered valuable insight into plaque regression (PR) or progression. However, the beneficial effects of PR on the long-term clinical outcomes in patients with acute coronary syndrome (ACS) remain unclear. We aimed to evaluate the impact of coronary plaque change in patients following primary percutaneous coronary intervention. We retrospectively analyzed data from 4 prospective clinical trials involving 173 patients with ACS who underwent serial IVUS of non-culprit lesions on statin treatment at baseline and at 6 or 8 months of follow-up. The relationship of the IVUS findings with the change in percent atheroma volume (PAV), on-treatment low-density lipoprotein cholesterol (LDL-C), and major adverse cardiac and cerebrovascular events (MACCE) were investigated. In our serial IVUS analysis, baseline plaque volume and PAV were 79.6 mm3 and 46.0%, respectively. The overall change in PAV was −1.5% [interquartile range (IQR): −4.1% to 1.0%], and PR (i.e. PAV change from baseline <0) was observed in 67.1% of patients. They were followed up observationally for a mean of 3.5 years and a total of 37 MACCE occurred. The rate of MACCE tended to be lower in patients with PR than in those without PR (18.1% vs. 28.7%, p = 0.14). A multivariate Cox hazard model analysis demonstrated that achievement of both PR and on-treatment low LDL-C levels (<70 mg/dL) was the only significant independent predictor of MACCE (hazard ratio: 0.42, 95% confidence interval: 0.19–0.88; p = 0.02). Achievement of both PR and sufficient lowering of the LDL-C was clinically important in post-ACS management. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD) is closely associated with a higher risk of cardiovascular dis-ease. However, whether patients with acute coronary syndrome (ACS) and CKD are at increased risk for long-term mortality after coronary revascularization remains unknown. Methods and results: Data from consecutive patients with ACS who had undergone coronary revasculari-zation, including percutaneous coronary intervention (PCI) and coronary artery bypass surgery (CABG) were analyzed. The estimated glomerular filtration rate (eGFR) was calculated using the current Japanese equation and CKD was defined as eGFR <60 mL/min/1.73 m2. Among 375 enrolled patients with ACS, 75 (20.0%) had CKD. During a follow-up period of 10.0± 3.4 years, the total number of deaths was 80 (21.3%), of which 36 (9.6%) were due to cardiovascular causes. Kaplan-Meier analysis showed that the presence of CKD was associated with a significant increase in mortality from all causes (log-rank test, p< 0.001) and cardiovascular mortality (p < 0.001). Cox proportional-hazard analysis revealed that CKD increased the risk of mortality with a hazard ratio of 2.31 (95% confidence interval (CI): 1.25-4.29, p = 0.008) and of cardiovascular death with a hazard ratio of 3.76 (95% CI: 1.60-8.80, p = 0.002) in patients with ACS. Conclusions: CKD is a powerful determinant of long-term all-cause and cardiovascular mortality after ACS. [ABSTRACT FROM AUTHOR]