Long-Term Prognostic Impact of OCT-Derived High-Risk Plaque Features: Extended Follow-Up of the CLIMA Study

JACC Cardiovasc Interv. 2025 Jun 9;18(11):1361-1372. doi: 10.1016/j.jcin.2025.04.044.

Abstract

Background: The long-term prognostic impact of presumed high-risk morphologic plaque features detected by intracoronary optical coherence tomographic (OCT) imaging remains largely unknown.

Objectives: The aim of this study was to assess the relationship between OCT plaque characteristics and cardiovascular outcomes throughout 5 years as part of the CLIMA (Relationship Between OCT Coronary Plaque Morphology and Clinical Outcome) study.

Methods: In the multicenter, international, prospective CLIMA study, 1,003 patients underwent OCT evaluation of the untreated proximal left anterior descending coronary artery. The 4 prespecified high-risk criteria were thin-cap fibroatheroma (TCFA), minimum luminal area <3.5 mm2, lipid arc >180°, and the presence of macrophages. The primary composite endpoint was cardiac death or target segment myocardial infarction (TS-MI).

Results: At 5-year follow-up (median 1,825 days; Q1-Q3: 1,137-1,825 days), the presence of all 4 OCT criteria, observed in 3.6% of patients at baseline, was independently associated with the primary endpoint (adjusted HR: 4.33; 95% CI: 2.01-9.33). The individual risks for cardiac death (HR: 3.73; 95% CI: 1.59-8.73) and TS-MI (HR: 7.02; 95% CI: 2.37-20.77) were significantly increased in patients with vs without all 4 OCT criteria. The combined presence of 4 OCT criteria remained significantly associated with the primary endpoint independently of high-intensity lipid-lowering therapy (adjusted HR: 2.94; 95% CI: 1.21-7.11). The presence of any TCFA was observed in 18.3% of patients and was similarly predictive of cardiac death and/or TS-MI.

Conclusions: The simultaneous presence of 4 OCT high-risk features, although infrequent, was independently associated with cardiac death or TS-MI on long-term follow-up. The presence of any TCFA was 5-fold as prevalent and similarly predictive of 5-year adverse outcomes. (Relationship Between OCT Coronary Plaque Morphology and Clinical Outcome [CLIMA]; NCT02883088).

Keywords: clinical events; coronary artery disease; myocardial infarction; optical coherence tomography; thin-cap fibroatheroma; vulnerable plaque.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Coronary Artery Disease* / diagnostic imaging
  • Coronary Artery Disease* / mortality
  • Coronary Artery Disease* / pathology
  • Coronary Artery Disease* / therapy
  • Coronary Vessels* / diagnostic imaging
  • Coronary Vessels* / pathology
  • Europe
  • Female
  • Fibrosis
  • Humans
  • Macrophages / pathology
  • Male
  • Middle Aged
  • Myocardial Infarction / etiology
  • Myocardial Infarction / mortality
  • Plaque, Atherosclerotic*
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Tomography, Optical Coherence*

Associated data

  • ClinicalTrials.gov/NCT02883088