Biccirè Flavio Giuseppe, Di Pietro Riccardo, Tu Shengxian, Budassi Simone, Ozaki Yukio, Romagnoli Enrico, Musto Carmine, Calligaris Giuseppe, Limbruno Ugo, Varricchione Giuseppe, Marco Valeria, Paoletti Giulia, Fabbiocchi Franco, Burzotta Francesco, Alfonso Fernando, Räber Lorenz, Arbustini Eloisa, Crea Filippo, Prati Francesco
Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy; Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Rome, Italy; Department of General and Specialized Surgery "Paride Stefanini", Sapienza University of Rome, Rome, Italy.
Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Rome, Italy.
Int J Cardiol. 2025 Sep 15;435:133410. doi: 10.1016/j.ijcard.2025.133410. Epub 2025 May 21.
Optical flow ratio (OFR) has recently been described to accurately compute coronary fractional flow reserve using optical coherence tomography (OCT), yet its prognostic impact remains unclear. The present study aimed to investigate the predictive value of coronary functional assessment, alone and combined with plaque morphology, by OCT.
In the present study, OFR software was applied to untreated coronary lesions undergoing OCT analysis in the multicenter, international, prospective CLIMA study. The primary endpoint was target-vessel failure (TVF) at 1 year, defined as a composite of cardiac death, target-vessel myocardial infarction (TV-MI) or target-vessel revascularization (TVR). The secondary endpoint was a composite of cardiac death or target segment MI.
Overall, 983 patients were included (median age 66 years, 24.8 % women). Lesions with OFR ≤0.80 (n = 120) showed more frequently a minimum lumen area < 3.5 mm2 (p < 0.001), a thin-cap fibroatheroma (TCFA) (p = 0.023) and a large lipid arc >180° (p = 0.001) as compared to OFR-preserved lesions. TVF was significantly more frequent in patients with versus without OFR-detected flow-limiting lesions (10.8 % and 4.8 %; HR 2.25, 95 %CI 1.21-4.21). This association was directionally consistent for TV-MI and TVR. Patients with both TCFA and impaired OFR lesions were at the highest risk of the primary (HR 6.47, 95 %CI 2.79-15.02) and secondary endpoint (HR 5.78, 95 %CI 1.92-17.43).
The presence of OFR-detected flow limitation was associated with high-risk morphological features and a higher incidence of adverse events. The combined presence of TCFA and OFR-derived flow limitation was associated with the highest incidence of primary and secondary endpoints.
最近有研究表明，利用光学相干断层扫描（OCT）技术，光流率（OFR）能够准确计算冠状动脉血流储备分数，但其对预后的影响尚不清楚。本研究旨在探讨通过OCT进行冠状动脉功能评估单独及联合斑块形态学评估的预测价值。
在本研究中，OFR软件应用于多中心、国际前瞻性CLIMA研究中接受OCT分析的未经治疗的冠状动脉病变。主要终点为1年时的靶血管失败（TVF），定义为心源性死亡、靶血管心肌梗死（TV-MI）或靶血管血运重建（TVR）的复合终点。次要终点为心源性死亡或靶节段心肌梗死的复合终点。
总体纳入983例患者（中位年龄66岁，女性占24.8%）。与OFR正常的病变相比，OFR≤0.80的病变（n = 120）更常出现最小管腔面积<3.5mm²（p < 0.001）、薄帽纤维粥样斑块（TCFA）（p = 0.023）和大于180°的大脂质弧（p = 0.001）。检测到OFR血流受限的患者中TVF显著高于未检测到的患者（10.8%和4.8%；HR 2.25，95%CI 1.21 - 4.21）。这种关联在TV-MI和TVR中方向一致。同时存在TCFA和OFR受损病变的患者发生主要终点（HR 6.47，95%CI 2.79 - 15.02）和次要终点（HR 5.78，95%CI 1.92 - 17.43）的风险最高。
检测到OFR血流受限与高危形态学特征及不良事件的较高发生率相关。TCFA与OFR衍生的血流受限同时存在与主要和次要终点的最高发生率相关。
