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2. The current treatment and predictors of outcome in elderly patients with non-ST-elevation myocardial infarction in an all comers population: the POPular Age registry

Author

Gimbel, M.E, primary, Chan Pin Yin, D.R.P.P, additional, Hermanides, R.S, additional, Kauer, F, additional, Tavenier, A.H, additional, Schellings, D, additional, Brinckman, S.L, additional, The, S.H.K, additional, Stoel, M.G, additional, Heestermans, A.A.C.M, additional, Rasoul, S, additional, Emans, M.E, additional, Peper, J, additional, Kelder, J.C, additional, and Ten Berg, J.M, additional

Published
2020
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6. Novelties in cardiac pacing. Left bundle branch pacing, a step-by-step guide

Author

Arif Al Nooryani, Tomasz Roleder, Balázs Berta, Juan F. Granada, Krzysztof Piotr Malinowski, Michael Magro, Enrico Fabris, Cyril Camaro, Javier Escaned, Floris Kauer, Holger Nef, Mark Kennedy, Hector Garcia Garcia, Sebastian Reith, Clemens von Birgelen, Fernando Rivero, Bruno Pereira, Renicus S Hermanides, Alexander Ijsselmuiden, Elvin Kedhi, Giuseppe De Luca, Wojciech Wojakowski, Fernando Alfonso, Health Technology & Services Research, Kedhi, E., Berta, B., Roleder, T., Hermanides, R. S., Fabris, E., 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., Al Nooryani, A., Rivero, F., Malinowski, K., De Luca, G., Garcia Garcia, H., Granada, J. F., and Wojakowski, W.

Subjects
Thin-cap fibroatheroma, Diabetes mellitu, medicine.medical_specialty, Population, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Predictive Value of Test, Coronary Artery Disease, Fractional flow reserve, Coronary Angiography, Coronary artery disease, Diabetes mellitus, Predictive Value of Tests, Internal medicine, Optical coherence tomography, Vulnerable plaque, Coronary Vessels, Humans, Prospective Studies, Tomography, Optical Coherence, Diabetes Mellitus, Fractional Flow Reserve, Myocardial, Plaque, Atherosclerotic, medicine, Clinical endpoint, Myocardial, Myocardial infarction, education, Tomography, Coronary Vessel, Atherosclerotic, Plaque, education.field_of_study, business.industry, Unstable angina, Hazard ratio, medicine.disease, n/a OA procedure, Prospective Studie, Optical Coherence, Cardiology, Cardiology and Cardiovascular Medicine, business, Mace, Human
Abstract

AimsThe aim of this study was to understand the impact of optical coherence tomography (OCT)-detected thin-cap fibroatheroma (TCFA) on clinical outcomes of diabetes mellitus (DM) patients with fractional flow reserve (FFR)-negative lesions.Methods and resultsCOMBINE OCT-FFR study was a prospective, double-blind, international, natural history study. After FFR assessment, and revascularization of FFR-positive lesions, patients with ≥1 FFR-negative lesions (target lesions) were classified in two groups based on the presence or absence of ≥1 TCFA lesion. The primary endpoint compared FFR-negative TCFA-positive patients with FFR-negative TCFA-negative patients for a composite of cardiac mortality, target vessel myocardial infarction, clinically driven target lesion revascularization or unstable angina requiring hospitalization at 18 months. Among 550 patients enrolled, 390 (81%) patients had ≥1 FFR-negative lesions. Among FFR-negative patients, 98 (25%) were TCFA positive and 292 (75%) were TCFA negative. The incidence of the primary endpoint was 13.3% and 3.1% in TCFA-positive vs. TCFA-negative groups, respectively (hazard ratio 4.65; 95% confidence interval, 1.99–10.89; P ConclusionsAmong DM patients with ≥1 FFR-negative lesions, TCFA-positive patients represented 25% of this population and were associated with a five-fold higher rate of MACE despite the absence of ischaemia. This discrepancy between the impact of vulnerable plaque and ischaemia on future adverse events may represent a paradigm shift for coronary artery disease risk stratification in DM patients.

Published
2021
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7. Thin-cap fibroatheroma predicts clinical events in diabetic patients with normal fractional flow reserve: the COMBINE OCT-FFR trial.

Author

Kedhi E, Berta B, Roleder T, Hermanides RS, Fabris E, IJsselmuiden AJJ, Kauer F, Alfonso F, von Birgelen C, Escaned J, Camaro C, Kennedy MW, Pereira B, Magro M, Nef H, Reith S, Al Nooryani A, Rivero F, Malinowski K, De Luca G, Garcia Garcia H, Granada JF, and Wojakowski W

Subjects
Coronary Angiography, Coronary Vessels diagnostic imaging, Humans, Predictive Value of Tests, Prospective Studies, Tomography, Optical Coherence, Coronary Artery Disease diagnostic imaging, Diabetes Mellitus, Fractional Flow Reserve, Myocardial, Plaque, Atherosclerotic diagnostic imaging
Abstract

Aims: The aim of this study was to understand the impact of optical coherence tomography (OCT)-detected thin-cap fibroatheroma (TCFA) on clinical outcomes of diabetes mellitus (DM) patients with fractional flow reserve (FFR)-negative lesions., Methods and Results: COMBINE OCT-FFR study was a prospective, double-blind, international, natural history study. After FFR assessment, and revascularization of FFR-positive lesions, patients with ≥1 FFR-negative lesions (target lesions) were classified in two groups based on the presence or absence of ≥1 TCFA lesion. The primary endpoint compared FFR-negative TCFA-positive patients with FFR-negative TCFA-negative patients for a composite of cardiac mortality, target vessel myocardial infarction, clinically driven target lesion revascularization or unstable angina requiring hospitalization at 18 months. Among 550 patients enrolled, 390 (81%) patients had ≥1 FFR-negative lesions. Among FFR-negative patients, 98 (25%) were TCFA positive and 292 (75%) were TCFA negative. The incidence of the primary endpoint was 13.3% and 3.1% in TCFA-positive vs. TCFA-negative groups, respectively (hazard ratio 4.65; 95% confidence interval, 1.99-10.89; P < 0.001). The Cox regression multivariable analysis identified TCFA as the strongest predictor of major adverse clinical events (MACE) (hazard ratio 5.12; 95% confidence interval 2.12-12.34; P < 0.001)., Conclusions: Among DM patients with ≥1 FFR-negative lesions, TCFA-positive patients represented 25% of this population and were associated with a five-fold higher rate of MACE despite the absence of ischaemia. This discrepancy between the impact of vulnerable plaque and ischaemia on future adverse events may represent a paradigm shift for coronary artery disease risk stratification in DM patients., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.)

Published
2021
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