Vulnerable plaque features and adverse events in patients with diabetes mellitus: a post hoc analysis of the COMBINE...

Area of Science:

• Cardiovascular Imaging
• Interventional Cardiology
• Diabetes Mellitus Research

Background:

• Thin-cap fibroatheroma (TCFA) is a high-risk lesion in cardiovascular disease.
• The combined impact of TCFA with other optical coherence tomography-detected vulnerability features (OCT-VFs) on adverse events is not well understood.
• Understanding these features is crucial for risk stratification in patients with diabetes.

Purpose of the Study:

• To assess the individual and combined prognostic value of OCT-VFs in predicting adverse cardiovascular events.
• To investigate the impact of OCT-VFs on the lesion-oriented composite endpoint (LOCE) in diabetic patients with non-ischaemic lesions.
• To determine if additional OCT-VFs modify the risk associated with TCFA.

Main Methods:

• Prospective, international, natural history study (COMBINE OCT-FFR).
• Included diabetic patients with non-culprit lesions (FFR > 0.80) assessed by OCT.
• Analyzed OCT-VFs (TCFA, reduced minimal lumen area, healed plaque, complicated plaque) and their association with LOCE over 5 years.

Main Results:

• TCFA, reduced minimal lumen area, healed plaque, and complicated plaque were present in 25.3%, 49.0%, 22.4%, and 29.9% of patients, respectively.
• The rate of LOCE increased from 6.3% to 55.6% in patients with no OCT-VFs versus those with concomitant HP, r-MLA, CP, and TCFA.
• Coexistence of TCFA with other OCT-VFs significantly increased the 5-year risk of LOCE.

Conclusions:

• In diabetic patients, TCFA is a strong predictor of future LOCE.
• Lesions with additional OCT-VFs, beyond TCFA alone, carry a substantially higher risk of adverse events.
• Further randomized trials are needed to confirm these findings and guide clinical practice.