Relationship between coronary plaque morphology of the left anterior descending artery and 12 months clinical outcome: the CLIMA study

Abstract

Aims The CLIMA study, on the relationship between coronary plaque morphology of the left anterior descending artery and twelve months clinical outcome, was designed to explore the predictive value of multiple high-risk plaque features in the same coronary lesion [minimum lumen area (MLA), fibrous cap thickness (FCT), lipid arc circumferential extension, and presence of optical coherence tomography (OCT)-defined macrophages] as detected by OCT. Composite of cardiac death and target segment myocardial infarction was the primary clinical endpoint. Methods and results From January 2013 to December 2016, 1003 patients undergoing OCT evaluation of the untreated proximal left anterior descending coronary artery in the context of clinically indicated coronary angiogram were prospectively enrolled at 11 independent centres (clinicaltrial.gov identifier NCT02883088). At 1-year, the primary clinical endpoint was observed in 37 patients (3.7%). In a total of 1776 lipid plaques, presence of MLA <3.5 mm2 [hazard ratio (HR) 2.1, 95% confidence interval (CI) 1.1–4.0], FCT <75 µm (HR 4.7, 95% CI 2.4–9.0), lipid arc circumferential extension >180° (HR 2.4, 95% CI 1.2–4.8), and OCT-defined macrophages (HR 2.7, 95% CI 1.2–6.1) were all associated with increased risk of the primary endpoint. The pre-specified combination of plaque features (simultaneous presence of the four OCT criteria in the same plaque) was observed in 18.9% of patients experiencing the primary endpoint and was an independent predictor of events (HR 7.54, 95% CI 3.1–18.6). Conclusion The simultaneous presence of four high-risk OCT plaque features was found to be associated with a higher risk of major coronary events.

Efficacy and Reproducibility of Attenuation-Compensated Optical Coherence Tomography for Assessing External Elastic Membrane Border and Plaque Composition in Native and Stented Segments ― An In Vivo and Histology-Based Study ―

“…Indeed, in the CLIMA study, which included 1,003 patients who had C-OCT imaging of the left anterior descending artery, C-OCT-derived plaque characteristics and in particular, the presence of an minimum lumen area <3.5 mm 2 , thin cap fibroatheroma phenotype, a lipid arc >180° and macrophage accumulation enabled prediction of the combined endpoint of cardiac death and target segment revascularization with a positive predictive value of 18.9%. 15 In the present study, we demonstrated that the AC technique enhances the efficacy of EEM border detection (76% vs. 65.5%) compared with C-OCT; using AC-OCT the EEM border was visible for an arc >180° in 76 (38%) images whereas in the C-OCT images it was visible in just 34 (17%). In addition, we found that AC-OCT was more effective than C-OCT in assessing the calcific tissue area.…”

Coronary Artery Microcalcification: Imaging and Clinical Implications

“…The same patients showed less advanced coronary artery stenosis, thus suggesting that the co-localization of macrophages and microcalcifications indicates an early phase of the atherosclerotic process which may progress into further calcification and inflammation. Taken together these observations indicate that OCT can provide both morphological and assessment of the level of disease activity, thus identifying patients at higher risk for subsequent coronary events [116].…”

Evaluation of the Efficacy of Computed Tomographic Coronary Angiography in Assessing Coronary Artery Morphology and Physiology: Rationale and Study Design

“…Cumulative evidence has demonstrated that plaque composition determines its vulnerability and enables more accurate risk stratification. Intravascular imaging studies have shown that even single vessel-plaque assessment provides useful prognostic information and identification of patients at risk [2,4,22,23]. Despite the increased cost and the risk of complications associated with intravascular imaging, this strategy may have a value in selected populations with a high cardiovascular risk such as the patients admitted with an acute coronary syndrome where the event rates at 1 year are as high as 20% [24,25].…”

“…Today, three intravascular imaging modalities are available in the clinical arena (intravascular ultrasound [IVUS], optical coherence tomography [OCT], and nearinfrared spectroscopy [NIRS]-IVUS). These have been studied in large prospective studies and it has been shown that they can provide useful prognostic information and detect vulnerable lesions and high-risk patients that are likely to suffer a cardiovascular event [1,2,4]. Histology studies have shown that NIRS-IVUS has an excellent accuracy in assessing plaque phenotype and it is the best modality for characterising its composition, as it combines an ultrasound probe that gives information about plaque and calcific tissue burden and a NIRS probe that can accurately detect the lipid component [5,6].…”