Relationship between <i>c</i>oronary p<i>l</i>aque morphology of the left anter<i>i</i>or descending artery and 12 <i>m</i>onths clinic<i>a</i>l outcome: the CLIMA study

TLDR

The CLIMA study investigates whether multiple high‑risk optical coherence tomography plaque features in the proximal left anterior descending artery predict 12‑month major coronary events. The study prospectively enrolled 1,003 patients undergoing OCT of the untreated proximal left anterior descending artery, with composite cardiac death and target‑segment myocardial infarction as the primary endpoint. At one year, 3.7% of patients experienced the primary endpoint, and the simultaneous presence of four high‑risk OCT features independently predicted events (HR 7.5).

Abstract

Abstract Aims The CLIMA study, on the relationship between coronary plaque morphology of the left anterior descending artery and twelve months clinical outcome, was designed to explore the predictive value of multiple high-risk plaque features in the same coronary lesion [minimum lumen area (MLA), fibrous cap thickness (FCT), lipid arc circumferential extension, and presence of optical coherence tomography (OCT)-defined macrophages] as detected by OCT. Composite of cardiac death and target segment myocardial infarction was the primary clinical endpoint. Methods and results From January 2013 to December 2016, 1003 patients undergoing OCT evaluation of the untreated proximal left anterior descending coronary artery in the context of clinically indicated coronary angiogram were prospectively enrolled at 11 independent centres (clinicaltrial.gov identifier NCT02883088). At 1-year, the primary clinical endpoint was observed in 37 patients (3.7%). In a total of 1776 lipid plaques, presence of MLA &amp;lt;3.5 mm2 [hazard ratio (HR) 2.1, 95% confidence interval (CI) 1.1–4.0], FCT &amp;lt;75 µm (HR 4.7, 95% CI 2.4–9.0), lipid arc circumferential extension &amp;gt;180° (HR 2.4, 95% CI 1.2–4.8), and OCT-defined macrophages (HR 2.7, 95% CI 1.2–6.1) were all associated with increased risk of the primary endpoint. The pre-specified combination of plaque features (simultaneous presence of the four OCT criteria in the same plaque) was observed in 18.9% of patients experiencing the primary endpoint and was an independent predictor of events (HR 7.54, 95% CI 3.1–18.6). Conclusion The simultaneous presence of four high-risk OCT plaque features was found to be associated with a higher risk of major coronary events.