Clinical impact of optical coherence tomography findings on culprit plaque in acute coronary syndrome: The OCT-FORMIDABLE study registry
Corresponding Author
Mario Iannaccone MD
“Città della Scienza e della Salute”, Department of Cardiology, University of Turin, Turin, Italy
Department of Cardiology, “S.G. Bosco Hospital”, Turin, Italy
Correspondence Mario Iannaccone, MD, Department of Cardiology, “Citta' della Scienza e della Salute”, University of Turin, Italy. Email: [email protected]Search for more papers by this authorGeraud Souteyrand MD
Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand 63000, France Cardio Vascular Interventional Therapy and Imaging (CaVITI), UMR CNRS 6284, Auvergne University, Clermont-Ferrand, France
Search for more papers by this authorGiampaolo Niccoli MD
Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
Search for more papers by this authorMassimo Mancone MD
Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, “Sapienza” University of Rome, Rome, Italy
Search for more papers by this authorGennaro Sardella Prof.
Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, “Sapienza” University of Rome, Rome, Italy
Search for more papers by this authorCorrado Tamburino Prof.
Cardio-thoracic-vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
Search for more papers by this authorChristian Templin MD
Department of Cardiology, Zurich University Hospital, Zurich, Switzerland
Search for more papers by this authorSebastiano Gili MD
“Città della Scienza e della Salute”, Department of Cardiology, University of Turin, Turin, Italy
Department of Cardiology, Zurich University Hospital, Zurich, Switzerland
Search for more papers by this authorGiacomo G Boccuzzi MD
Department of Cardiology, “S.G. Bosco Hospital”, Turin, Italy
Search for more papers by this authorFabrizio D'Ascenzo MD
“Città della Scienza e della Salute”, Department of Cardiology, University of Turin, Turin, Italy
Search for more papers by this authorCorresponding Author
Mario Iannaccone MD
“Città della Scienza e della Salute”, Department of Cardiology, University of Turin, Turin, Italy
Department of Cardiology, “S.G. Bosco Hospital”, Turin, Italy
Correspondence Mario Iannaccone, MD, Department of Cardiology, “Citta' della Scienza e della Salute”, University of Turin, Italy. Email: [email protected]Search for more papers by this authorGeraud Souteyrand MD
Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand 63000, France Cardio Vascular Interventional Therapy and Imaging (CaVITI), UMR CNRS 6284, Auvergne University, Clermont-Ferrand, France
Search for more papers by this authorGiampaolo Niccoli MD
Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
Search for more papers by this authorMassimo Mancone MD
Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, “Sapienza” University of Rome, Rome, Italy
Search for more papers by this authorGennaro Sardella Prof.
Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, “Sapienza” University of Rome, Rome, Italy
Search for more papers by this authorCorrado Tamburino Prof.
Cardio-thoracic-vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
Search for more papers by this authorChristian Templin MD
Department of Cardiology, Zurich University Hospital, Zurich, Switzerland
Search for more papers by this authorSebastiano Gili MD
“Città della Scienza e della Salute”, Department of Cardiology, University of Turin, Turin, Italy
Department of Cardiology, Zurich University Hospital, Zurich, Switzerland
Search for more papers by this authorGiacomo G Boccuzzi MD
Department of Cardiology, “S.G. Bosco Hospital”, Turin, Italy
Search for more papers by this authorFabrizio D'Ascenzo MD
“Città della Scienza e della Salute”, Department of Cardiology, University of Turin, Turin, Italy
Search for more papers by this authorFunding information: None
Abstract
Background
Aim of this study was to evaluate the clinical impact of the culprit plaque features assessed by optical coherence tomography (OCT) in patients with acute coronary syndrome (ACS).
Methods
The OCT-FORMIDABLE register enrolled retrospectively all consecutive patients who perform OCT on culprit plaque in patients with ACS in nine European centres. The primary endpoint was the prevalence of culprit plaque rupture (CPR) in patients experiencing major adverse cardiovascular events (MACEs). Secondary endpoint was the prevalence necrotic core with macrophage infiltrations (NCMI) in the patients experiencing MACEs.
Results
Two-hundred and nine patients were included in the study. Mean age was 60.1 ± 12.9 years old, 19.1% were females. Main clinical presentation was ST-elevation myocardial infarction (55%). At OCT analysis, CPR was observed in 71.8% patients, while 31.6% presented NCMI. During follow-up (12.6 ± 14.5 months), 11% of the patients experienced MACEs. The presence of CPR (HR 3.7,1.4-9.8, P < .01) and NCMI (HR 3.3,1.6-6.6, P < .01) were independent predictors for MACEs, while dual antiplatelet therapy with prasugrel/ticagrelor at discharge (HR 0.2,0.1-0.6, P < .01) were protective. The protective impact of new antiplatelet drugs was reported only in patients with CPR while in patients without any of the baseline clinical or procedural features impacted on MACEs.
Conclusions
CPR and the presence of NCMI are independent predictors of worse outcome. Patients with CPR seem to benefit more of an intensive therapy, both from a pharmacological and interventional point of view. (NCT02486861)
Supporting Information
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