TY - JOUR
T1 - Long-Term Prognostic Impact of OCT-Derived High-Risk Plaque Features: Extended Follow-Up of the CLIMA Study
AU - Biccirè, Flavio Giuseppe
AU - Fabbiocchi, Franco
AU - Gatto, Laura
AU - La Manna, Alessio
AU - Ozaki, Yukio
AU - Romagnoli, Enrico
AU - Marco, Valeria
AU - Boi, Alberto
AU - Fineschi, Massimo
AU - Piedimonte, Giulio
AU - Cerrato, Enrico
AU - Musto, Carmine
AU - Taglieri, Nevio
AU - Di Giorgio, Alessandro
AU - Vizzari, Giampiero
AU - Ruscica, Giovanni
AU - Canova, Paolo Angelo
AU - Vergallo, Rocco
AU - Burzotta, Francesco
AU - Limbruno, Ugo
AU - Albertucci, Mario
AU - Räber, Lorenz
AU - Crea, Filippo
AU - Alfonso, Fernando
AU - Arbustini, Eloisa
AU - Stone, Gregg W
AU - Prati, Francesco
PY - 2025
Y1 - 2025
N2 - Background: The long-term prognostic impact of presumed high-risk morphologic plaque features detected by intracoronary optical coherence tomographic (OCT) imaging remains largely unknown. Objectives: The aim of this study was to assess the relationship between OCT plaque characteristics and cardiovascular outcomes throughout 5 years as part of the CLIMA (Relationship Between OCT Coronary Plaque Morphology and Clinical Outcome) study. Methods: In the multicenter, international, prospective CLIMA study, 1,003 patients underwent OCT evaluation of the untreated proximal left anterior descending coronary artery. The 4 prespecified high-risk criteria were thin-cap fibroatheroma (TCFA), minimum luminal area <3.5 mm2, lipid arc >180°, and the presence of macrophages. The primary composite endpoint was cardiac death or target segment myocardial infarction (TS-MI). Results: At 5-year follow-up (median 1,825 days; Q1-Q3: 1,137-1,825 days), the presence of all 4 OCT criteria, observed in 3.6% of patients at baseline, was independently associated with the primary endpoint (adjusted HR: 4.33; 95% CI: 2.01-9.33). The individual risks for cardiac death (HR: 3.73; 95% CI: 1.59-8.73) and TS-MI (HR: 7.02; 95% CI: 2.37-20.77) were significantly increased in patients with vs without all 4 OCT criteria. The combined presence of 4 OCT criteria remained significantly associated with the primary endpoint independently of high-intensity lipid-lowering therapy (adjusted HR: 2.94; 95% CI: 1.21-7.11). The presence of any TCFA was observed in 18.3% of patients and was similarly predictive of cardiac death and/or TS-MI. Conclusions: The simultaneous presence of 4 OCT high-risk features, although infrequent, was independently associated with cardiac death or TS-MI on long-term follow-up. The presence of any TCFA was 5-fold as prevalent and similarly predictive of 5-year adverse outcomes. (Relationship Between OCT Coronary Plaque Morphology and Clinical Outcome [CLIMA]; NCT02883088)
AB - Background: The long-term prognostic impact of presumed high-risk morphologic plaque features detected by intracoronary optical coherence tomographic (OCT) imaging remains largely unknown. Objectives: The aim of this study was to assess the relationship between OCT plaque characteristics and cardiovascular outcomes throughout 5 years as part of the CLIMA (Relationship Between OCT Coronary Plaque Morphology and Clinical Outcome) study. Methods: In the multicenter, international, prospective CLIMA study, 1,003 patients underwent OCT evaluation of the untreated proximal left anterior descending coronary artery. The 4 prespecified high-risk criteria were thin-cap fibroatheroma (TCFA), minimum luminal area <3.5 mm2, lipid arc >180°, and the presence of macrophages. The primary composite endpoint was cardiac death or target segment myocardial infarction (TS-MI). Results: At 5-year follow-up (median 1,825 days; Q1-Q3: 1,137-1,825 days), the presence of all 4 OCT criteria, observed in 3.6% of patients at baseline, was independently associated with the primary endpoint (adjusted HR: 4.33; 95% CI: 2.01-9.33). The individual risks for cardiac death (HR: 3.73; 95% CI: 1.59-8.73) and TS-MI (HR: 7.02; 95% CI: 2.37-20.77) were significantly increased in patients with vs without all 4 OCT criteria. The combined presence of 4 OCT criteria remained significantly associated with the primary endpoint independently of high-intensity lipid-lowering therapy (adjusted HR: 2.94; 95% CI: 1.21-7.11). The presence of any TCFA was observed in 18.3% of patients and was similarly predictive of cardiac death and/or TS-MI. Conclusions: The simultaneous presence of 4 OCT high-risk features, although infrequent, was independently associated with cardiac death or TS-MI on long-term follow-up. The presence of any TCFA was 5-fold as prevalent and similarly predictive of 5-year adverse outcomes. (Relationship Between OCT Coronary Plaque Morphology and Clinical Outcome [CLIMA]; NCT02883088)
KW - clinical events
KW - coronary artery disease
KW - myocardial infarction
KW - optical coherence tomography
KW - thin-cap fibroatheroma
KW - vulnerable plaque
KW - clinical events
KW - coronary artery disease
KW - myocardial infarction
KW - optical coherence tomography
KW - thin-cap fibroatheroma
KW - vulnerable plaque
UR - https://publicatt.unicatt.it/handle/10807/317127
UR - https://www.scopus.com/inward/citedby.uri?partnerID=HzOxMe3b&scp=105006597232&origin=inward
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=105006597232&origin=inward
U2 - 10.1016/j.jcin.2025.04.044
DO - 10.1016/j.jcin.2025.04.044
M3 - Article
SN - 1936-8798
VL - 18
SP - 1361
EP - 1372
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 11
ER -