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Clinical impact of optical coherence tomography findings on culprit plaque in acute coronary syndrome: The OCT‐FORMIDABLE study registry
Author(s) -
Iannaccone Mario,
Souteyrand Geraud,
Niccoli Giampaolo,
Mancone Massimo,
Sardella Gennaro,
Tamburino Corrado,
Templin Christian,
Gili Sebastiano,
Boccuzzi Giacomo G,
D'Ascenzo Fabrizio
Publication year - 2018
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27633
Subject(s) - medicine , optical coherence tomography , culprit , acute coronary syndrome , cardiology , computed tomography , radiology , myocardial infarction
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)