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

Francesco Prati, Enrico Romagnoli, Laura Gatto, Alessio La Manna, Francesco Burzotta, Yukio Ozaki, Valeria Marco, Alberto Boi, Massimo Fineschi, Franco Fabbiocchi, Nevio Taglieri, Giampaolo Niccoli, Carlo Trani, Francesco Versaci, Giuseppe Calligaris, Gianni Ruscica, Alessandro Di Giorgio, Rocco Vergallo, Mario Albertucci, Giuseppe Biondi-ZoccaiCorrado Tamburino, Filippo Crea, Fernando Alfonso, Eloisa Arbustini

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)383-391
Number of pages9
JournalEuropean Heart Journal
Volume41
Issue number3
DOIs
Publication statusPublished - Jan 14 2020

Keywords

  • Clinical outcome
  • Coronary plaque
  • Optical coherence tomography
  • Personalized medicine
  • Registry

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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