{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T17:09:55Z","timestamp":1791220195193,"version":"4.1.0"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2024,8,14]],"date-time":"2024-08-14T00:00:00Z","timestamp":1723593600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Isala Hartcentrum"},{"DOI":"10.13039\/100006279","name":"St Jude Medical","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006279","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100011949","name":"Abbott Vascular","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011949","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,12,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>To evaluate the individual as well as combined impact of optical coherence tomography-detected vulnerability features (OCT-VFs) in the prediction of major adverse cardiovascular events (MACEs) in non-ischaemic lesions in patients with diabetes mellitus (DM).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>The COMBINE OCT-FFR (NCT02989740) was a prospective, double-blind, international, natural-history study that included patients with DM having \u22651 lesions with a fractional flow reserve &amp;gt; 0.80, undergoing systematic OCT assessment. Pre-specified OCT-VFs included thin-cap fibroatheroma (TCFA), reduced minimal lumen area (r-MLA), high plaque burden (h-PB), and complicated plaque (CP). The primary endpoint (MACE) was a composite of cardiac mortality, target vessel myocardial infarction, clinically driven target lesion revascularization, or hospitalization for unstable angina up to 5 years, analysed according to the presence of these OCT-VFs, both individually and in combination. TCFA, r-MLA, h-PB, and CP were identified in 98 (25.1%), 159 (40.8%), 56 (14.4%), and 116 (29.8%) patients, respectively. The primary endpoint rate increased progressively from 6.9% to 50.0% (HR = 10.10; 95% CI, 3.37\u201330.25, P &amp;lt; 0.001) in patients without OCT-VFs compared with those with concomitant h-PB, r-MLA, CP, and TCFA. Importantly, while TCFA, h-PB, r-MLA, and CP were individually associated with the primary endpoint, the presence of two or more OCT-VFs significantly increased the likelihood of adverse events at 5 years.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>In patients with DM and non-ischaemic lesions, TCFA, h-PB, r-MLA, and CP were predictors of adverse events. However, the presence of two or more OCT-VFs significantly increased the likelihood of MACE at 5 years. Further studies are warranted to confirm these findings and their potential clinical implications in a randomized fashion.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjci\/jeae210","type":"journal-article","created":{"date-parts":[[2024,8,14]],"date-time":"2024-08-14T05:21:46Z","timestamp":1723612906000},"page":"38-48","source":"Crossref","is-referenced-by-count":6,"title":["Increased incidence of adverse events in diabetes mellitus patients with combined multiple vulnerable plaque features: new insights from the COMBINE OCT-FFR trial"],"prefix":"10.1093","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7784-5501","authenticated-orcid":false,"given":"David","family":"del Val","sequence":"first","affiliation":[{"name":"Cardiology Department, Hospital Universitario de La Princesa , Madrid ,","place":["Spain"]},{"name":"CIBERCV, Instituto de Investigaci\u00f3n Sanitaria, IIS-IP, Hospital Universitario de La Princesa , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Balazs","family":"Berta","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center, Semmelweis University , Budapest ,","place":["Hungary"]},{"name":"Isala Hartcentrum , Zwolle ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomasz","family":"Roleder","sequence":"additional","affiliation":[{"name":"Division of Cardiology and Structural Heart Diseases, Medical University of Silesia , Katowice ,","place":["Poland"]},{"name":"Department of Cardiology, Wroclaw Medical University , Wroclaw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krzysztof","family":"Malinowski","sequence":"additional","affiliation":[{"name":"Department of Bioinformatics and Telemedicine, Faculty of Medicine, Jagiellonian University Medical College , Krak\u00f3w ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1544-9594","authenticated-orcid":false,"given":"Teresa","family":"Bastante","sequence":"additional","affiliation":[{"name":"Cardiology Department, Hospital Universitario de La Princesa , Madrid ,","place":["Spain"]},{"name":"CIBERCV, Instituto de Investigaci\u00f3n Sanitaria, IIS-IP, Hospital Universitario de La Princesa , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3931-2565","authenticated-orcid":false,"given":"Renicus S","family":"Hermanides","sequence":"additional","affiliation":[{"name":"Isala Hartcentrum , Zwolle ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3681-5207","authenticated-orcid":false,"given":"Wojciech","family":"Wojakowski","sequence":"additional","affiliation":[{"name":"Division of Cardiology and Structural Heart Diseases, Medical University of Silesia , Katowice ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9458-0736","authenticated-orcid":false,"given":"Enrico","family":"Fabris","sequence":"additional","affiliation":[{"name":"Cardiovascular Department, University of Trieste , Trieste ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Cuesta","sequence":"additional","affiliation":[{"name":"Cardiology Department, Hospital Universitario de La Princesa , Madrid ,","place":["Spain"]},{"name":"CIBERCV, Instituto de Investigaci\u00f3n Sanitaria, IIS-IP, Hospital Universitario de La Princesa , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"De Luca","sequence":"additional","affiliation":[{"name":"Division of Cardiology, AOU \u2018Policlinico G. 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