Elvin Kedhi1,2, Balazs Berta3,4, Tomasz Roleder5, Renicus S Hermanides4, Enrico Fabris6, Alexander J J IJsselmuiden7, Floris Kauer8, Fernando Alfonso9, Clemens von Birgelen10,11, Javier Escaned12, Cyril Camaro13, Mark W Kennedy14, Bruno Pereira15, Michael Magro16, Holger Nef17, Sebastian Reith18, Arif Al Nooryani19, Fernando Rivero9, Krzysztof Malinowski20,21, Giuseppe De Luca22, Hector Garcia Garcia23, Juan F Granada24,25, Wojciech Wojakowski2. 1. Erasmus Hospital, Université libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium. 2. Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziolowa 45, 40-635, Katowice, Poland. 3. Heart and Vascular Center, Semmelweis University, Gaál József út 9, 1122 Budapest, Hungary. 4. Isala Hartcentrum, Dokter van Heesweg 2 8025 AB, Zwolle, the Netherlands. 5. Regional Specialist Hospital, Kamieńskiego 73A, 51-124 Wrocław, Poland. 6. Cardiovascular Department, University of Trieste, Via Pietro Valdoni, 7, 34149 Trieste, Italy. 7. Department of Cardiology, Amphia Ziekenhuis, Langendijk 75, 4819 EV Breda, the Netherlands. 8. Department of Cardiology, Albert Schweitzer Ziekenhuis, Albert Schweitzerplaats 25, 3318 AT Dordrecht, the Netherlands. 9. Department of Cardiology, Hospital Universitario de La Princesa, Calle de Diego de León, 62, 28006 Madrid, Spain. 10. Thoraxcentrum Twente, Medisch Spectrum Twente, Koningstraat 1, 7512 KZ Enschede, the Netherlands. 11. Technical Medical Centre, University of Twente, Hallenweg 5, 7522 NH Enschede, the Netherlands. 12. Hospital Clínico San Carlos, Calle del Prof Martín Lagos, s/n, 28040 Madrid, Spain. 13. University Medical Center Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands. 14. Beaumont Hospital, Beaumont Rd, Beaumont, Dublin, Ireland. 15. INCCI-Haertz Zenter, 2 A Rue Nicolas Ernest Barblé, 1210 Luxembourg, Luxembourg. 16. Tweesteden Ziekenhuis, Doctor Deelenlaan 5, 5042 AD Tilburg, the Netherlands. 17. Universitätsklinikum, Gießen/Marburg, Klinikstraße 33, 35392 Gießen, Germany. 18. Uniklinik RWTH, Pauwelsstraße 30, 52074 Aachen, Germany. 19. Al Qassimi Hospital - Wasit St - MughaidirSuburbAlKhezamiaSharjah, United Arab Emirates. 20. Krakow Cardiovascular Research Institute (KCRI), B, Miechowska 5, 30-055 Krakow, Poland. 21. Second Department of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Krakow, Poland. 22. AziendaOspedaliera-Universitaria "Maggiore dellaCarità", Eastern Piedmont University, Corso Giuseppe Mazzini, 18, 28100 Novara, Italy. 23. MedStar Washington Hospital Center, 110 Irving St., NW Washington, DC 20010, USA. 24. Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10019, USA. 25. Columbia University Medical Center NYC, 622 W 168th St, New York, NY 10032, USA.
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.
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.
Authors: Federico Marin; Roberto Scarsini; Dimitrios Terentes-Printzios; Rafail A Kotronias; Flavio Ribichini; Adrian P Banning; Giovanni Luigi De Maria Journal: Curr Cardiol Rev Date: 2022
Authors: Anna van Veelen; Niels M R van der Sangen; Ronak Delewi; Marcel A M Beijk; Jose P S Henriques; Bimmer E P M Claessen Journal: J Clin Med Date: 2022-03-01 Impact factor: 4.241
Authors: Piotr Baruś; Jakub Modrzewski; Karolina Gumiężna; Piotr Dunaj; Marcin Głód; Adrian Bednarek; Wojciech Wańha; Tomasz Roleder; Janusz Kochman; Mariusz Tomaniak Journal: J Clin Med Date: 2022-07-13 Impact factor: 4.964