Dataset Information

Long-term outcomes of patients with normal fractional flow reserve and thin-cap fibroatheroma.

ABSTRACT:

Background

The long-term prognostic implications of fractional flow reserve (FFR)-negative lesions hosting vulnerable plaques remain unsettled.

Aims

The aim of this study was to evaluate the association of non-ischaemic lesions hosting optical coherence tomography (OCT)-detected thin-cap fibroatheromas (TCFA) with first and recurrent cardiovascular events during follow-up up to 5 years in a diabetes mellitus (DM) patient population.

Methods

COMBINE OCT-FFR is a prospective, international, double-blind, natural history study. Patients with DM and with ≥1 FFR-negative lesion were classified into 2 groups based on the presence or absence of ≥1 TCFA lesion. The primary endpoint (PE) is a composite of cardiac mortality, target vessel-related myocardial infarction (TV-MI), clinically driven target lesion revascularisation (TLR), or unstable angina (UA) requiring hospitalisation during follow-up up to 5 years.

Results

Among 390 DM patients (age 67.5±9 years; 37% female) with ≥1 FFR-negative lesion, 292 (74.9%) were TCFA-negative while 98 (25.1%) were TCFA-positive. The PE occurred more frequently in TCFA-positive than in TCFA-negative patients (21.4% vs 8.2%, hazard ratio [HR] 2.89, 95% confidence interval [CI]: 1.61-5.20; p<0.001; 6.42 vs 2.46 events per 100 patient-years, rate ratio [RR] 2.61, 95% CI: 1.38-4.90; p=0.002). Furthermore, when TV-MI, TLR, and UA were treated as recurrent components of the PE, TCFA-positive patients experienced a higher risk of recurrent events (HR 2.89, 95% CI; 1.74-4.80; p<0.001; 13.45 vs 2.87 events per 100 patient-years, RR 4.69, 95% CI: 2.86-7.83; p<0.001). A multivariable analysis identified the presence of TCFA as an independent predictor of the PE (HR 2.76, 95% CI: 1.53-4.97; p<0.001).

Conclusions

OCT-detected TCFA-positive lesions, although not ischaemia-generating, are associated with an increased risk of adverse events during long-term follow-up.

Clinicaltrials

gov: NCT02989740.

SUBMITTER: Fabris E

PROVIDER: S-EPMC9909454 | biostudies-literature | 2023 Feb

REPOSITORIES: biostudies-literature

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Publications

Long-term outcomes of patients with normal fractional flow reserve and thin-cap fibroatheroma.

Fabris Enrico E Berta Balázs B Hommels Tobias T Roleder Tomasz T Hermanides Renicus S RS Rivero Fernando F von Birgelen Clemens C Escaned Javier J Camaro Cyril C Kennedy Mark W MW Pereira Bruno B Magro Michael M Nef Holger H Reith Sebastian S Roleder-Dylewska Magda M Gasior Pawel P Malinowski Krzysztof Piotr KP De Luca Giuseppe G Garcia-Garcia Hector M HM Granada Juan F JF Wojakowski Wojciech W Kedhi Elvin E

EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 20230206 13

<h4>Background</h4>The long-term prognostic implications of fractional flow reserve (FFR)-negative lesions hosting vulnerable plaques remain unsettled.<h4>Aims</h4>The aim of this study was to evaluate the association of non-ischaemic lesions hosting optical coherence tomography (OCT)-detected thin-cap fibroatheromas (TCFA) with first and recurrent cardiovascular events during follow-up up to 5 years in a diabetes mellitus (DM) patient population.<h4>Methods</h4>COMBINE OCT-FFR is a prospective, ...[more]

PMID: 36170036

Similar Datasets

Project description:BackgroundCoronary computed tomography angiography-derived fractional flow reserve (FFRCT) is a per-vessel index reflecting cumulative hemodynamic burden while coronary events occur in focal lesions.ObjectivesThe authors sought to evaluate the additive prognostic value of the local gradient of FFRCT (FFRCT gradient) in addition to FFRCT to predict future coronary events.MethodsThe current study included 245 patients (634 vessels) who underwent coronary computed tomography angiography within 6 to 36 months before the index angiography, of which 209 vessels had future coronary events and 425 vessels did not. Future coronary events were defined as a composite of vessel-specific myocardial infarction or urgent revascularization during a mean interval of 1.5 years. Pre-existing disease patterns were classified according to FFRCT of ≤0.80 and FFRCT gradient of ≥0.025/mm.ResultsBoth FFRCT (per 0.01 decrease; adjusted HR: 1.040; 95% CI: 1.029-1.051; P < 0.001) and FFRCT gradient (per 0.01 increase; adjusted HR: 1.144; 95% CI: 1.101-1.190; P < 0.001) were significantly associated with the risk of future coronary events. Lesions with FFRCT gradient of ≥0.025/mm showed significantly higher risk of future coronary events than those with FFRCT gradient of <0.025/mm in both the FFRCT >0.80 (49.2% vs 30.1%; HR: 2.069; 95% CI: 1.265-3.385; P = 0.004) and FFRCT ≤0.80 groups (60.9% vs 38.3%; HR: 1.988; 95% CI: 1.317-2.999; P =0 .001). Adding FFRCT gradient into the model with FFRCT alone showed significantly increased predictability of future coronary events (global chi-square: 45.8 vs 39.9; P = 0.015).ConclusionsPatients with high FFRCT gradient showed increased risk of future coronary events irrespective of FFRCT. Integrating both FFRCT and FFRCT gradient showed incremental predictability of future coronary events compared with FFRCT alone. (Prediction and Validation of Clinical Course of Coronary Artery Disease With CT-Derived Non-Invasive Hemodynamic Phenotyping and Plaque Characterization [DESTINY Study]; NCT04794868).

Dataset Information

Long-term outcomes of patients with normal fractional flow reserve and thin-cap fibroatheroma.

Background

Aims

Methods

Results

Conclusions

Clinicaltrials

Publications

Long-term outcomes of patients with normal fractional flow reserve and thin-cap fibroatheroma.

Similar Datasets

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