Even coronary lesions that fractional flow reserve (FFR) readings have indicated are of low risk for causing ischemia could be of high risk if optical coherence tomography (OCT) intravascular imaging indicates they are vulnerable to rupture, suggests a prospective study of patients with diabetes referred for angiography.
Of coronary plaques in a cohort that were low-risk by FFR, about one fourth were characterized as having thin-cap fibroatheroma (TCFA) at OCT imaging. That is, they registered as having a high lipid content that is thought to make the lesion vulnerable to rupture, potentially triggering an ischemic event.
Moreover, in the study, the risk for clinical events such as death, hospitalization, and myocardial infarction (MI) associated with the target lesion was fourfold higher at 18 months in patients with vs those without the target lesions containing TCFA.
The findings, therefore, suggest that adding OCT imaging to FFR may sharpen risk assessment of potential target lesions, at least for patients with diabetes, in whom coronary disease tends to follow a more aggressive progression than occurs with patients who do not have diabetes. The findings also support a role for OCT in identifying coronary plaques that could potentially be threatening in the future.
The trial, called
