Paradigm Shift in the Treatment of Patients With ACS

Inclusion Criteria:

• Men or non-pregnant women >18 years of age and < 75 years of age
• Patients undergo cardiac catheterization for ACS. Patients with STEMI, NSTEMI, and UAP will be included. STEMI will be defined as continuous chest pain for >30 minutes, arrival at the hospital within 12 hours from chest pain onset, ST-segment elevation >0.1 mV in at least two contiguous leads, or new left bundle-branch block on the 12-lead electrocardiogram (ECG), and elevated cardiac markers (troponin T/I or creatine kinase-MB). NSTEMI will be defined as a progressive crescendo pattern of angina or angina at rest, in the absence of ST-segment elevation on the 12-lead ECG, with elevated cardiac markers. UAP will be defined as new onset angina, progressive crescendo pattern of angina, or angina at rest.
• Culprit lesion located in a native coronary artery
• TIMI flow grade 3 and diameter stenosis < 70% on angiogram
• Definite erosion defined by OCT
• Patients able to provide written informed consent

Exclusion Criteria:

Left ventricular ejection fraction < 30%.

• Life expectancy < 1 year.
• Contraindication to the contrast media.
• Creatinine level > 2.0 mg/dL or end-stage kidney disease.
• Serious liver dysfunction.
• Patients with hemodynamic or electrical instability (including shock).
• Any contraindication against the use of ticagrelor.
• Investigator considers the patient is not suitable.