Biccirè Flavio Giuseppe, Fabbiocchi Franco, Gatto Laura, La Manna Alessio, Ozaki Yukio, Romagnoli Enrico, Marco Valeria, Boi Alberto, Fineschi Massimo, Piedimonte Giulio, Cerrato Enrico, Musto Carmine, Taglieri Nevio, Di Giorgio Alessandro, Vizzari Giampiero, Ruscica Giovanni, Canova Paolo Angelo, Vergallo Rocco, Burzotta Francesco, Limbruno Ugo, Albertucci Mario, Räber Lorenz, Crea Filippo, Alfonso Fernando, Arbustini Eloisa, Stone Gregg W, Prati Francesco
Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Rome, Italy; Centro per la Lotta Contro l'Infarto - CLI Foundation, Rome, Italy; Department of General and Specialized Surgery "Paride Stefanini," Sapienza University of Rome, Rome, Italy.
IRCCS Galeazzi-Sant'Ambrogio Hospital, University of Milan, Milan, Italy.
JACC Cardiovasc Interv. 2025 Jun 9;18(11):1361-1372. doi: 10.1016/j.jcin.2025.04.044.
The long-term prognostic impact of presumed high-risk morphologic plaque features detected by intracoronary optical coherence tomographic (OCT) imaging remains largely unknown.
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.
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 mm, lipid arc >180°, and the presence of macrophages. The primary composite endpoint was cardiac death or target segment myocardial infarction (TS-MI).
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.
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).
冠状动脉内光学相干断层扫描（OCT）成像检测到的假定高风险形态学斑块特征的长期预后影响在很大程度上仍不清楚。
作为CLIMA（OCT冠状动脉斑块形态与临床结局的关系）研究的一部分，本研究旨在评估OCT斑块特征与5年内心血管结局之间的关系。
在多中心、国际性、前瞻性的CLIMA研究中，1003例患者接受了未经治疗的左前降支近端冠状动脉的OCT评估。4个预先设定的高风险标准为薄帽纤维粥样斑块（TCFA）、最小管腔面积<3.5mm、脂质弧>180°和巨噬细胞的存在。主要复合终点是心源性死亡或靶节段心肌梗死（TS-MI）。
在5年随访时（中位时间1825天；第一四分位数-第三四分位数：1137-1825天），在基线时3.6%的患者中观察到的所有4个OCT标准的存在与主要终点独立相关（校正后HR：4.33；95%CI：2.01-9.33）。有4个OCT标准的患者与没有这些标准的患者相比，心源性死亡（HR：3.73；95%CI：1.59-8.73）和TS-MI（HR：7.02；95%CI：2.37-20.77）的个体风险显著增加。4个OCT标准的联合存在与主要终点仍独立相关，与高强度降脂治疗无关（校正后HR：2.94；95%CI：1.21-7.11）。18.3%的患者观察到任何TCFA的存在，其同样可预测心源性死亡和/或TS-MI。
4个OCT高风险特征同时存在，虽然不常见，但在长期随访中与心源性死亡或TS-MI独立相关。任何TCFA的存在普遍程度高出5倍，同样可预测5年不良结局。（OCT冠状动脉斑块形态与临床结局的关系[CLIMA]；NCT02883088）
