TY  - BOOK
AU  - Garcia-Garcia, Hector M
TI  - Thin-Cap Fibroatheroma Rather Than Any Lipid Plaques Increases the Risk of Cardiovascular Events in Diabetic Patients: Insights From the COMBINE OCT-FFR Trial
SN  - 1941-7640
PY  - 2022///
KW  - *Coronary Artery Disease
KW  - *Diabetes Mellitus
KW  - *Fractional Flow Reserve, Myocardial
KW  - *Plaque, Atherosclerotic
KW  - Aged
KW  - Coronary Angiography
KW  - Coronary Artery Disease/dg [Diagnostic Imaging]
KW  - Coronary Artery Disease/pa [Pathology]
KW  - Coronary Artery Disease/th [Therapy]
KW  - Coronary Vessels
KW  - Diabetes Mellitus/di [Diagnosis]
KW  - Female
KW  - Humans
KW  - Lipids
KW  - Male
KW  - Middle Aged
KW  - Plaque, Atherosclerotic/pa [Pathology]
KW  - Predictive Value of Tests
KW  - Prospective Studies
KW  - Tomography, Optical Coherence/mt [Methods]
KW  - Treatment Outcome
KW  - MedStar Heart & Vascular Institute
KW  - Journal Article
KW  - Multicenter Study
N1  - Available online from MWHC library: 2008 - present
N2  - 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); CLINICALTRIALS: gov; Unique identifier: NCT02989740; 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; 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; REGISTRATION: URL: https://www; 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]; P<0.01), and to non-LRP patients (13.3% versus 1.9%; HR, 7.7 [95% CI, 1.7-33.9]; P<0.01), whereas ThCFA patients had risk similar to non-LRP patients (3.8% versus 1.9%; HR, 2.0 [95% CI, 0.42-9.7]; P=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)
UR  - https://dx.doi.org/10.1161/CIRCINTERVENTIONS.121.011728
ER  -