FFR-Negative Nonculprit High-Risk Plaques and Clinical Outcomes in High-Risk Populations: An Individual Patient-Data Pooled Analysis From COMBINE (OCT-FFR) and PECTUS-obs

• DOI: 10.1161/circinterventions.124.014667
• Publication Date: 2025-01-22T10:01:27Z
• Authors: Rick H.J.A. Volle...; Andi Rroku; Jan-Quinten Mol; Renicus S. Herman...; Maarten van Leeuwen; Balázs Berta; Martijn Meuwissen; Fernando Alfonso; Wojciech Wojakowski; Anouar Belkacemi; Tomasz Roleder; Elvin Kedhi; Niels van Royen; Elvin Kedhi; Balázs Berta; Tomasz Roleder; Renicus S. Herman...; Enrico Fabris; Alexander J.J. Ij...; Floris Kauer; Fernando Alfonso; Clemens von Birgelen; Javier Escaned; Cyril Camaro; Mark W. Kennedy; Bruno Pereira; Michael Magro; Holger Nef; Sebastian Reith; Arif Al Nooryani; Fernando Rivero; Krzysztof Malinowski; Giuseppe De Luca; Hector Garcia Garcia; Juan F. Granada; Wojciech Wojakowski; Jan-Quinten Mol; Rick H.J.A. Volle...; Anouar Belkacemi; Renicus S. Herman...; Martijn Meuwissen; Alexey V. Protopopov; Peep Laanmets; Oleg V. Krestyaninov; R. Dennert; Rohit M. Oemrawsingh; Jan-Peter van Kuijk; Karin Arkenbout; Dirk J. van der H...; Saman Rasoul; Erik Lipsic; Laura Rodwell; Cyril Camaro; Peter Damman; Tomasz Roleder; Elvin Kedhi; Maarten van Leeuwen; Robert-Jan M. van...; Niels van Royen
• Keywords: Fractional Flow Reserve

BACKGROUND: Despite fractional flow reserve (FFR)–guided deferral of revascularization, recurrent events in patients with diabetes or after myocardial infarction remain common. This study aimed to assess the association between FFR-negative but high-risk nonculprit lesions and clinical outcomes. METHODS: is a patient-level pooled analysis prospective natural-history COMBINE (OCT-FFR) (Optical Coherence Tomography Morphologic Fractional Flow Reserve Assessment Diabetes Mellitus Patients) PECTUS-obs (Identification Risk Factors for Acute Coronary Events by OCT After STEMI NSTEMI Patients With Residual Non- Limiting Lesions). Optical coherence tomography was performed on all (FFR >0.80) native lesions. plaque were compared those without plaque. A defined presence at least 2 prespecified criteria: (1) lipid arc ≥90 o , (2) minimum fibrous cap thickness <65 µm, (3) either rupture thrombus. The primary end points major adverse cardiovascular (composite all-cause mortality, nonfatal infarction, unplanned revascularization excluding stent-failure–related nonattributable events) target lesion failure cardiac death, vessel revascularization). RESULTS: Among 810 patients, 450 (55.6%) had history 482 (59.5%) presented infarction. At 1 identified 271 (33.5%) 287 (30.6%) Over median follow-up 761 (interquartile range, 731–1175) days, associated (hazard ratio, 2.127 [95% CI, 1.451–3.120]; P <0.001) lesion-level 2.623 1.559–4.414]; <0.001). risk outcomes increased copresence multiple features. CONCLUSIONS: are patient- These findings emphasize additional value intracoronary imaging REGISTRATION: URL: https://clinicaltrials.gov ; Unique identifier: NCT02989740; NCT03857971.