{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T03:43:44Z","timestamp":1781581424264,"version":"3.54.5"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Autopsy studies have established that thin-cap fibroatheromas (TCFAs) are the most frequent cause of fatal coronary events. In living patients, optical coherence tomography (OCT) has sufficient resolution to accurately differentiate TCFA from thick-cap fibroatheroma (ThCFA) and not lipid rich plaque (non-LRP). However, the impact of OCT-detected plaque phenotype of nonischemic lesions on future adverse events remains unknown. Therefore, we studied the natural history of OCT-detected TCFA, ThCFA, and non-LRP in patients enrolled in the prospective multicenter COMBINE FFR-OCT trial (Combined Optical Coherence Tomography Morphologic and Fractional Flow Reserve Hemodynamic Assessment of Non-Culprit Lesions to Better Predict Adverse Event Outcomes in Diabetes Mellitus Patients).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>In the COMBINE FFR-OCT trial, patients with diabetes and \u22651 lesion with a fractional flow reserve &gt;0.80 underwent OCT evaluation and were clinically followed for 18 months. A composite primary end point of cardiac death, target vessel-related myocardial infarction, target-lesion revascularization, and hospitalization for unstable angina was evaluated in relation to OCT-based plaque morphology.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              A total of 390 patients (age 67.5\u00b19 years; 63% male) with \u22651 nonischemic lesions underwent OCT evaluation: 284 (73%) had \u22651 LRP and 106 (27%) non-LRP lesions. Among LRP patients, 98 (34.5%) had \u22651 TCFA. The primary end point occurred in 7% of LRP patients compared with 1.9% of non-LRP patients (7.0% versus 1.9%; hazard ratio [HR], 3.9 [95% CI, 0.9\u201316.5];\n              <jats:italic>P<\/jats:italic>\n              =0.068; log rank-\n              <jats:italic>P<\/jats:italic>\n              =0.049). However, within LRP patients, TCFA patients had a much higher risk for primary end point compared with ThCFA (13.3% versus 3.8%; HR, 3.8 [95% CI, 1.5\u20139.5];\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01), and to non-LRP patients (13.3% versus 1.9%; HR, 7.7 [95% CI, 1.7\u201333.9];\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01), whereas ThCFA patients had risk similar to non-LRP patients (3.8% versus 1.9%; HR, 2.0 [95% CI, 0.42\u20139.7];\n              <jats:italic>P<\/jats:italic>\n              =0.38). Multivariable analyses identified TCFA as the strongest independent predictor of primary end point (HR, 6.79 [95% CI, 1.50\u201330.72];\n              <jats:italic>P<\/jats:italic>\n              =0.013).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Among diabetes patients with fractional flow reserve-negative lesions, patients carrying TCFA lesions represent only one-third of LRP patients and are associated with a high risk of future events while patients carrying LRP-ThCFA and non-LRP lesions portend benign outcomes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Registration:<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              ; Unique identifier: NCT02989740.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circinterventions.121.011728","type":"journal-article","created":{"date-parts":[[2022,5,17]],"date-time":"2022-05-17T18:01:56Z","timestamp":1652810516000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":28,"title":["Thin-Cap Fibroatheroma Rather Than Any Lipid Plaques Increases the Risk of Cardiovascular Events in Diabetic Patients: Insights From the COMBINE OCT\u2013FFR Trial"],"prefix":"10.1161","volume":"15","clinical-trial-number":[{"clinical-trial-number":"nct02989740","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9458-0736","authenticated-orcid":true,"given":"Enrico","family":"Fabris","sequence":"first","affiliation":[{"name":"Cardiovascular Department, University of Trieste, Italy (E.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3431-8821","authenticated-orcid":true,"given":"Balasz","family":"Berta","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.B.)."},{"name":"Isala Hartcentrum, Zwolle, the Netherlands (B.B., R.S.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomasz","family":"Roleder","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Wroclaw, Poland (T.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renicus S.","family":"Hermanides","sequence":"additional","affiliation":[{"name":"Isala Hartcentrum, Zwolle, the Netherlands (B.B., R.S.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander J.J.","family":"IJsselmuiden","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Amphia Ziekenhuis, Breda, the Netherlands (A.J.J.I.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Floris","family":"Kauer","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands (F.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7480-2511","authenticated-orcid":true,"given":"Fernando","family":"Alfonso","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain (F.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clemens","family":"von Birgelen","sequence":"additional","affiliation":[{"name":"Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands (C.v.B.)."},{"name":"Technical Medical Centre, Health Technology and Services Research, University of Twente, Enschede, Netherlands (C.v.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4932-0112","authenticated-orcid":true,"given":"Javier","family":"Escaned","sequence":"additional","affiliation":[{"name":"Hospital Cl\u00ednico San Carlos, Madrid, Spain (J.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6170-8318","authenticated-orcid":true,"given":"Cyril","family":"Camaro","sequence":"additional","affiliation":[{"name":"University Medical Center Radboudumc, Nijmegen, the Netherlands (C.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark W.","family":"Kennedy","sequence":"additional","affiliation":[{"name":"Beaumont Hospital, Dublin, Ireland (M.W.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8191-6613","authenticated-orcid":true,"given":"Bruno","family":"Pereira","sequence":"additional","affiliation":[{"name":"INCCI- Haertz Zenter, Luxembourg (B.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0581-3532","authenticated-orcid":true,"given":"Michael","family":"Magro","sequence":"additional","affiliation":[{"name":"Tweesteden Ziekenhuis, Tilburg, the Netherlands (M.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holger","family":"Nef","sequence":"additional","affiliation":[{"name":"Universit\u00e4tsklinikum, Gie\u00dfen\/Marburg, Germany (H.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Reith","sequence":"additional","affiliation":[{"name":"Uniklinik RWTH, Aachen, Germany (S.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9892-8752","authenticated-orcid":true,"given":"Magda","family":"Roleder-Dylewska","sequence":"additional","affiliation":[{"name":"Department Medical University of Silesia, Katowice, Poland (M.R.-D., P.G., W.W., E.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8564-7257","authenticated-orcid":true,"given":"Pawel","family":"Gasior","sequence":"additional","affiliation":[{"name":"Department Medical University of Silesia, Katowice, Poland (M.R.-D., P.G., W.W., E.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2189-0498","authenticated-orcid":true,"given":"Krzysztof","family":"Malinowski","sequence":"additional","affiliation":[{"name":"Department of Bioinformatics and Telemedicine, Faculty of Medicine, Jagiellonian University Medical College, Krak\u00f3w, Poland (K.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6031-2899","authenticated-orcid":true,"given":"Giuseppe","family":"De Luca","sequence":"additional","affiliation":[{"name":"Eastern Piedmont University, Novara, Italy (G.D.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5100-0471","authenticated-orcid":true,"given":"Hector M.","family":"Garcia-Garcia","sequence":"additional","affiliation":[{"name":"Interventional Cardiology, MedStar Washington Hospital Center, Washington, D.C. (H.M.G.-G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2399-8320","authenticated-orcid":true,"given":"Juan F.","family":"Granada","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Foundation, New York (J.F.G.)."},{"name":"Columbia University Medical Center NYC, NY (J.F.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3681-5207","authenticated-orcid":true,"given":"Wojciech","family":"Wojakowski","sequence":"additional","affiliation":[{"name":"Department Medical University of Silesia, Katowice, Poland (M.R.-D., P.G., W.W., E.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6930-0085","authenticated-orcid":true,"given":"Elvin","family":"Kedhi","sequence":"additional","affiliation":[{"name":"Department Medical University of Silesia, Katowice, Poland (M.R.-D., P.G., W.W., E.K.)."},{"name":"Erasmus Hospital, Universit\u00e9 Libre de Bruxelles (ULB), Brussels, Belgium (E.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht484"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1002358"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)31794-5"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00249-X"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1126\/science.1957169"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab433"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-016-0464-8"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.09.079"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.07.998"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz520"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeab028"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.21037\/cdt-20-684"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11883-020-00890-4"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.09.547"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.4244\/EIJ-D-20-00501"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2015.12.023"}],"container-title":["Circulation: Cardiovascular Interventions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCINTERVENTIONS.121.011728","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T02:21:33Z","timestamp":1715566893000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCINTERVENTIONS.121.011728"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5]]},"references-count":16,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2022,5]]}},"alternative-id":["10.1161\/CIRCINTERVENTIONS.121.011728"],"URL":"https:\/\/doi.org\/10.1161\/circinterventions.121.011728","relation":{},"ISSN":["1941-7640","1941-7632"],"issn-type":[{"value":"1941-7640","type":"print"},{"value":"1941-7632","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5]]},"assertion":[{"value":"2021-12-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-03-04","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-04-29","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}