1. Thin-Cap Fibroatheroma Rather Than Any Lipid Plaques Increases the Risk of Cardiovascular Events in Diabetic Patients: Insights From the COMBINE OCT–FFR Trial
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Enrico Fabris, Balasz Berta, Tomasz Roleder, Renicus S. Hermanides, Alexander J.J. IJsselmuiden, Floris Kauer, Fernando Alfonso, Clemens von Birgelen, Javier Escaned, Cyril Camaro, Mark W. Kennedy, Bruno Pereira, Michael Magro, Holger Nef, Sebastian Reith, Magda Roleder-Dylewska, Pawel Gasior, Krzysztof Malinowski, Giuseppe De Luca, Hector M. Garcia-Garcia, Juan F. Granada, Wojciech Wojakowski, Elvin Kedhi, Health Technology & Services Research, Fabris, E., Berta, B., Roleder, T., Hermanides, R. S., Ijsselmuiden, A. J. J., Kauer, F., Alfonso, F., Von Birgelen, C., Escaned, J., Camaro, C., Kennedy, M. W., Pereira, B., Magro, M., Nef, H., Reith, S., Roleder-Dylewska, M., Gasior, P., Malinowski, K., De Luca, G., Garcia-Garcia, H. M., Granada, J. F., Wojakowski, W., and Kedhi, E.
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Male ,coronary stenosi ,coronary stenosis ,optical coherence ,atherosclerotic ,coronary artery disease ,diabetes ,fractional flow reserve ,myocardial ,myocardial infarction ,plaque ,tomography ,Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] ,Coronary Angiography ,Predictive Value of Tests ,Diabetes Mellitus ,Humans ,Prospective Studies ,Aged ,Middle Aged ,Coronary Vessels ,Lipids ,Plaque, Atherosclerotic ,n/a OA procedure ,Fractional Flow Reserve, Myocardial ,Treatment Outcome ,diabete ,Female ,Cardiology and Cardiovascular Medicine ,Tomography, Optical Coherence - Abstract
Background:Autopsy studies have established that thin-cap fibroatheromas (TCFAs) are the most frequent cause of fatal coronary events. In living patients, optical coherence tomography (OCT) has sufficient resolution to accurately differentiate TCFA from thick-cap fibroatheroma (ThCFA) and not lipid rich plaque (non-LRP). However, the impact of OCT-detected plaque phenotype of nonischemic lesions on future adverse events remains unknown. Therefore, we studied the natural history of OCT-detected TCFA, ThCFA, and non-LRP in patients enrolled in the prospective multicenter COMBINE FFR-OCT trial (Combined Optical Coherence Tomography Morphologic and Fractional Flow Reserve Hemodynamic Assessment of Non-Culprit Lesions to Better Predict Adverse Event Outcomes in Diabetes Mellitus Patients).Methods:In the COMBINE FFR-OCT trial, patients with diabetes and ≥1 lesion with a fractional flow reserve >0.80 underwent OCT evaluation and were clinically followed for 18 months. A composite primary end point of cardiac death, target vessel-related myocardial infarction, target-lesion revascularization, and hospitalization for unstable angina was evaluated in relation to OCT-based plaque morphology.Results:A total of 390 patients (age 67.5±9 years; 63% male) with ≥1 nonischemic lesions underwent OCT evaluation: 284 (73%) had ≥1 LRP and 106 (27%) non-LRP lesions. Among LRP patients, 98 (34.5%) had ≥1 TCFA. The primary end point occurred in 7% of LRP patients compared with 1.9% of non-LRP patients (7.0% versus 1.9%; hazard ratio [HR], 3.9 [95% CI, 0.9–16.5];P=0.068; log rank-P=0.049). However, within LRP patients, TCFA patients had a much higher risk for primary end point compared with ThCFA (13.3% versus 3.8%; HR, 3.8 [95% CI, 1.5–9.5];PPP=0.38). Multivariable analyses identified TCFA as the strongest independent predictor of primary end point (HR, 6.79 [95% CI, 1.50–30.72];P=0.013).Conclusions:Among diabetes patients with fractional flow reserve-negative lesions, patients carrying TCFA lesions represent only one-third of LRP patients and are associated with a high risk of future events while patients carrying LRP-ThCFA and non-LRP lesions portend benign outcomes.Registration:URL:https://www.clinicaltrials.gov; Unique identifier: NCT02989740.
- Published
- 2022
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