Author + information
- Balazs Berta1,
- Tomasz Roleder2,
- Mark Kennedy3,
- Alexander Ijsselmuiden4,
- Holger Nef5,
- Javier Escaned6,
- Fernando Alfonso7 and
- Elvin Kedhi8
- 1Isala Hospital, Zwolle, Netherlands
- 2Third Division of Cardiology, Medical University of Silesia, Katowice, Poland
- 3Beaumont Hospital, Portarlington, Laois, Ireland
- 4Amphia hospital- Medical center Breda, Breda LX, Netherlands
- 5University of Giessen, Giessen, Germany
- 6Hospital Clínico San Carlos, Madrid, Spain
- 7Hospital Universitario de la Princesa, Madrid, Spain
- 8Isala Klinieken Zwolle, Zwolle, Netherland
The incidence of thin-cap fibroatheroma (TCFA) and plaque rupture (PR) in angiographic intermediate and fractional flow reserve (FFR) negative (>0.80) lesions in diabetes mellitus (DM) patients is unknown. Furthermore, whether the prevalence of TCFA and PR differs in acute coronary syndrome (ACS) vs. non-ACS patients is also unknown. FFR has not been validated in lesions presenting a PR. The aim of this study was to determine the prevalence of TCFA and PR in FFR negative lesions of DM patients with versus without ACS.
We performed the optical coherence tomography (OCT) analysis of the first 100 patients from the COMBINE study (NCT02989740); a multi-center, prospective natural history study which combines OCT morphologic and FFR hemodynamic assessment of non-culprit lesions to better predict adverse event outcomes in DM patients.
From 100 patients, 30 had ACS and 70 had stable or silent angina. The clinical risk factors did not differ between the two groups. The median angiographic diameter stenosis was 50% IQR [50-60%] in both groups (p=0.216). The results of PR and TCFA in these two groups are given in Table 1. No significant differences were observed between ACS vs. non-ACS group in the incidence of TCFA (p=0.301). Importantly, the incidence of PR was similarly high in both groups and represented 11.2% of the total lesions (p=0.913). PR was predominantly deriving from TCFA lesions in both groups (p=0.509).
|%||ACS patients n=30||Non-ACS patients n=70||All patients n=100||p value|
|Number of lesions||43||100||143|
|TCFA||9 (20.9%)||14 (14.0%)||23 (16.1%)||0.301|
|Plaque rupture||5 (11.6%)||11 (11.0%)||16 (11.2%)||0.913|
|- PR lesions with TCFA||4 (80.0%)||5 (45.5%)||9 (56.3%)||0.509|
The major finding of this analysis is that ≥11% of FFR negative lesions in DM patients had a PR, a condition for which FFR has not been validated. Furthermore, the prevalence of TCFA in DM patients was not impacted by clinical syndrome at presentation, proving again that ACS and stable/silent angina are just two different presentations of the same disease.
IMAGING: Imaging: Intravascular