Thin-cap fibroatheroma predicts clinical events in diabetic patients with normal fractional flow reserve: the COMBINE OCT–FFR trial Article Swipe
Elvin Kedhi
,
Balázs Berta
,
Tomasz Roleder
,
Renicus S. Hermanides
,
Enrico Fabris
,
Alexander Ijsselmuiden
,
Floris Kauer
,
Fernándo Alfonso
,
Clemens von Birgelen
,
Javier Escaned
,
Cyril Camaro
,
Mark Kennedy
,
Bruno Pereira
,
Michael Magro
,
Holger Nef
,
Sebastian Reith
,
Arif Al Nooryani
,
Fernando Rivero
,
Krzysztof Piotr Malinowski
,
Giuseppe De Luca
,
Héctor García García
,
Juan F. Granada
,
Wojciech Wojakowski
·
YOU?
·
· 2021
· Open Access
·
· DOI: https://doi.org/10.1093/eurheartj/ehab433
YOU?
·
· 2021
· Open Access
·
· DOI: https://doi.org/10.1093/eurheartj/ehab433
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.
Related Topics
Concepts
Medicine
Fractional flow reserve
Cardiology
Internal medicine
Coronary angiography
Myocardial infarction
Metadata
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- article
- Language
- en
- Landing Page
- https://doi.org/10.1093/eurheartj/ehab433
- https://academic.oup.com/eurheartj/article-pdf/42/45/4671/41427136/ehab433.pdf
- OA Status
- bronze
- Cited By
- 249
- References
- 31
- Related Works
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- OpenAlex ID
- https://openalex.org/W3191267295
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W3191267295Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.1093/eurheartj/ehab433Digital Object Identifier
- Title
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Thin-cap fibroatheroma predicts clinical events in diabetic patients with normal fractional flow reserve: the COMBINE OCT–FFR trialWork title
- Type
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articleOpenAlex work type
- Language
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enPrimary language
- Publication year
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2021Year of publication
- Publication date
-
2021-06-25Full publication date if available
- Authors
-
Elvin Kedhi, Balázs Berta, Tomasz Roleder, Renicus S. Hermanides, Enrico Fabris, Alexander Ijsselmuiden, Floris Kauer, Fernándo Alfonso, Clemens von Birgelen, Javier Escaned, Cyril Camaro, Mark Kennedy, Bruno Pereira, Michael Magro, Holger Nef, Sebastian Reith, Arif Al Nooryani, Fernando Rivero, Krzysztof Piotr Malinowski, Giuseppe De Luca, Héctor García García, Juan F. Granada, Wojciech WojakowskiList of authors in order
- Landing page
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https://doi.org/10.1093/eurheartj/ehab433Publisher landing page
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https://academic.oup.com/eurheartj/article-pdf/42/45/4671/41427136/ehab433.pdfDirect link to full text PDF
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YesWhether a free full text is available
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bronzeOpen access status per OpenAlex
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https://academic.oup.com/eurheartj/article-pdf/42/45/4671/41427136/ehab433.pdfDirect OA link when available
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Medicine, Fractional flow reserve, Cardiology, Internal medicine, Coronary angiography, Myocardial infarctionTop concepts (fields/topics) attached by OpenAlex
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249Total citation count in OpenAlex
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2025: 62, 2024: 70, 2023: 67, 2022: 39, 2021: 11Per-year citation counts (last 5 years)
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31Number of works referenced by this work
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10Other works algorithmically related by OpenAlex
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