Aims To study if any qualitative or quantitative optical coherence tomography (OCT)
variables in combination with thin cap fibroatheroma (TCFA) patients could improve
the identification of lesions at risk for future major adverse cardiac events (MACEs).
Methods and results From the combined optical coherence tomography morphologic and
fractional flow reserve hemodynamic assessment of non- culprit lesions to better predict
adverse event outcomes in diabetes mellitus patients: COMBINE (OCT-FFR) trial database
(NCT02989740), we performed a detailed assessment OCT qualitative and quantitative
variables in TCFA carrying diabetes mellitus (DM) patients with vs. without MACE during
follow-up. MACEs were defined as a composite of cardiac death, target vessel myocardial
infarction, clinically driven target lesion revascularization, and hospitalization
for unstable angina. From the 390 fractional flow reserve (FFR)-negative DM patients,
98 (25.2%) had >= 1 OCT-detected TCFA, of which 13 (13.3%) had MACE and 85 (86.7%)
were event-free (non-MACE). The baseline characteristics were similar between both
groups; however, a smaller minimal lumen area (MLA) and lower mean FFR value were
observed in MACE group (1.80 vs. 2.50 mm(2), P = 0.01, and 0.85 vs. 0.89, P = 0.02,
respectively). Prevalence of healed plaque (HP) was higher in the MACE group (53.85
vs. 21.18%, P = 0.01). TCFA were predominantly located proximal to the MLA. TCFA area
was smaller in the MACE group, while no difference was observed regarding the lesion
area. Conclusion Within TCFA carrying patients, a smaller MLA, lower FFR values, and
TCFA location adjacent to a HP were associated with future MACE. Carpet-like measured
lesion area surface was similar, while the TCFA area was smaller in the MACE arm,
and predominantly located proximal to the MLA.
