Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Rome, Italy; Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy.
Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain.
Int J Cardiol. 2022 Jan 1;346:8-12. doi: 10.1016/j.ijcard.2021.11.042. Epub 2021 Nov 17.
The ability of optical coherence tomography (OCT) to recognize intraplaque macrophage infiltration is now well acknowledged. This post-hoc analysis of the CLIMA study aimed to address the clinical impact of the circumferential extension of OCT-defined macrophages and their location at one year follow-up.
The multicentre CLIMA study enrolled 1003 patients undergoing OCT evaluation of the untreated proximal left anterior descending (LAD) coronary artery. Measurements of circumferential extension of macrophages and measurements of the distance from intima-lumen contour to macrophages string were performed at the plaque cross-section judged as containing the greatest amount of macrophages. The main study endpoint was a composite of cardiac death, myocardial infarction (MI) and/or target vessel revascularization (TVR).
Patients with large macrophage arc (p = 0.001) and superficial macrophage arc (p < 0.001) showed a higher one-year incidence of the main one-year composite endpoint. Consistently hypertension (p = 0.018), family history of CAD (p = 0.046), diabetes mellitus (p = 0.036), lower ejection fraction (p = 0.009) and chronic kidney disease (p = 0.019) were more frequently found in patients experiencing the main composite endpoint. At multivariate Cox regression analysis, fibrous cap thickness < 75 μm (HR 2.51, 95% 1.46-4.32), presence of large (HR 1.97, 95%CI 1.16-3.35, p = 0.012) and superficial (HR 1.72, 95%CI 1.02-2.90; p = 0.040) macrophage arc remained independent predictors of the main composite endpoint. Large macrophage arc was associated with target LAD related MI.
The present post-hoc analysis of the CLIMA showed that the circumferential extension of macrophages and their location are related to a composite endpoint of cardiac death, MI and/or TVR.
光学相干断层扫描（OCT）识别斑块内巨噬细胞浸润的能力已得到广泛认可。CLIMA 研究的这项事后分析旨在探讨 OCT 定义的巨噬细胞的周向延伸及其在一年随访时位置对临床的影响。
多中心 CLIMA 研究纳入了 1003 例接受未经治疗的左前降支（LAD）近端 OCT 评估的患者。在判断包含最多巨噬细胞的斑块横截面上，对巨噬细胞的周向延伸进行测量，并对从内膜-腔轮廓到巨噬细胞串的距离进行测量。主要研究终点是心脏死亡、心肌梗死（MI）和/或靶血管血运重建（TVR）的复合终点。
大巨噬细胞弧（p=0.001）和浅巨噬细胞弧（p<0.001）的患者一年时主要复合终点的发生率更高。高血压（p=0.018）、CAD 家族史（p=0.046）、糖尿病（p=0.036）、射血分数较低（p=0.009）和慢性肾病（p=0.019）在发生主要复合终点的患者中更为常见。多变量 Cox 回归分析显示，纤维帽厚度<75μm（HR 2.51，95%CI 1.46-4.32）、存在大（HR 1.97，95%CI 1.16-3.35，p=0.012）和浅（HR 1.72，95%CI 1.02-2.90；p=0.040）巨噬细胞弧仍然是主要复合终点的独立预测因素。大巨噬细胞弧与靶 LAD 相关 MI 有关。
CLIMA 的这项事后分析表明，巨噬细胞的周向延伸及其位置与心脏死亡、MI 和/或 TVR 的复合终点有关。
