背景:薄帽纤维粥样硬化(TCFA)病变与未来主要不良心血管事件的高风险相关。然而,其他光学相干断层扫描检测到的易损性特征(OCT-VFs)及其与TCFA的相互作用对预测不良事件的影响尚不清楚.
目的:我们旨在评估OCT-VFs在预测糖尿病(DM)患者非缺血性病变中病变导向复合终点(LOCE)发生率方面的个体以及联合预后影响。
方法:组合OCT-FFR(ClinicalTrials.gov:NCT02989740)双盲,国际,纳入有≥1个非罪犯病变且血流储备分数>0.80的DM患者进行系统OCT评估的自然史研究.OCT-VF包括以下内容:TCFA,减少最小管腔面积(r-MLA),愈合斑块(HP),和复杂的斑块(CP)。主端点,LOCE-心脏死亡率的复合,靶血管心肌梗死,或临床驱动的靶病变血运重建长达5年-根据这些OCT-VFs的存在进行分析,无论是单独还是组合。
结果:TCFA,r-MLA,98例(25.3%)中发现HP和CP,190(49.0%),87(22.4%),116名(29.9%)患者,分别。与合并HP患者相比,无OCT-VFs患者的主要终点发生率从6.3%逐渐上升至55.6%(风险比15.2,95%置信区间:4.53-51.0;p<0.001)。r-MLA,CP,和TCFA。TCFA与其他OCT-VFs共存导致5年时LOCE的风险增加。
结论:在非缺血性病变的DM患者中,TCFA是未来LOCE事件的最强预测因子。然而,与OCT检测的单独TCFA相比,存在额外OCT-VFs的病变与更高的不良事件风险相关.需要进一步的随机研究来证实这些发现及其潜在的临床意义。
BACKGROUND: Thin-cap fibroatheroma (TCFA) lesions are associated with a high risk of future major adverse cardiovascular events. However, the impact of other optical coherence tomography-detected vulnerability features (OCT-VFs) and their interplay with TCFA in predicting adverse events remains unknown.
OBJECTIVE: We aimed to evaluate the individual as well as the combined prognostic impact of OCT-VFs in predicting the incidence of the lesion-oriented composite endpoint (LOCE) in non-ischaemic lesions in patients with diabetes mellitus (DM).
METHODS: COMBINE OCT-FFR (ClinicalTrials.gov: NCT02989740) was a prospective, double-blind, international, natural history
study that included DM patients with ≥1 non-culprit lesions with a fractional flow reserve>0.80 undergoing systematic OCT assessment. OCT-VFs included the following: TCFA, reduced minimal lumen area (r-MLA), healed plaque (HP), and complicated plaque (CP). The primary endpoint, LOCE - a composite of cardiac mortality, target vessel myocardial infarction, or clinically driven target lesion revascularisation up to 5 years - was analysed according to the presence of these OCT-VFs, both individually and in combination.
RESULTS: TCFA, r-MLA, HP and CP were identified in 98 (25.3%), 190 (49.0%), 87 (22.4%), and 116 (29.9%) patients, respectively. The primary endpoint rate increased progressively from 6.3% to 55.6% (hazard ratio 15.2, 95% confidence interval: 4.53-51.0; p<0.001) in patients without OCT-VFs as compared to patients with concomitant HP, r-MLA, CP, and TCFA. The coexistence of TCFA with other OCT-VFs resulted in an increased risk of the LOCE at 5 years.
CONCLUSIONS: In DM patients with non-ischaemic lesions, TCFA was the strongest predictor of future LOCE events. However, lesions that present additional OCT-VFs are associated with a higher risk of adverse events than OCT-detected TCFA alone. Further randomised studies are warranted to confirm these findings and their potential clinical implications.