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Relationship between the amount and location of macrophages and clinical outcome: subanalysis of the clima-study
International Journal of Cardiology ( IF 3.5 ) Pub Date : 2021-11-17 , DOI: 10.1016/j.ijcard.2021.11.042
Laura Gatto 1 , Fernando Alfonso 2 , Giulia Paoletti 3 , Francesco Burzotta 4 , Alessio La Manna 5 , Simone Budassi 1 , Flavio Giuseppe Biccirè 6 , Massimo Fineschi 7 , Valeria Marco 8 , Franco Fabbiocchi 9 , Rocco Vergallo 4 , Alberto Boi 10 , Giovanni Ruscica 8 , Francesco Versaci 11 , Nevio Taglieri 12 , Giuseppe Calligaris 9 , Mario Albertucci 8 , Enrico Romagnoli 4 , Vito Ramazzotti 13 , Corrado Tamburino 5 , Filippo Crea 4 , Yukio Ozaki 14 , Eloisa Arbustini 15 , Francesco Prati 16
Affiliation  

Background

The ability of optical coherence tomography (OCT) to recognize intraplaque macrophage infiltration is now well acknowledged. This post-hoc analysis of the CLIMA study aimed to address the clinical impact of the circumferential extension of OCT-defined macrophages and their location at one year follow-up.

Methods

The multicentre CLIMA study enrolled 1003 patients undergoing OCT evaluation of the untreated proximal left anterior descending (LAD) coronary artery. Measurements of circumferential extension of macrophages and measurements of the distance from intima-lumen contour to macrophages string were performed at the plaque cross-section judged as containing the greatest amount of macrophages. The main study endpoint was a composite of cardiac death, myocardial infarction (MI) and/or target vessel revascularization (TVR).

Results

Patients with large macrophage arc (p = 0.001) and superficial macrophage arc (p < 0.001) showed a higher one-year incidence of the main one-year composite endpoint. Consistently hypertension (p = 0.018), family history of CAD (p = 0.046), diabetes mellitus (p = 0.036), lower ejection fraction (p = 0.009) and chronic kidney disease (p = 0.019) were more frequently found in patients experiencing the main composite endpoint. At multivariate Cox regression analysis, fibrous cap thickness < 75 μm (HR 2.51, 95% 1.46–4.32), presence of large (HR 1.97, 95%CI 1.16–3.35, p = 0.012) and superficial (HR 1.72, 95%CI 1.02–2.90; p = 0.040) macrophage arc remained independent predictors of the main composite endpoint. Large macrophage arc was associated with target LAD related MI.

Conclusion

The present post-hoc analysis of the CLIMA showed that the circumferential extension of macrophages and their location are related to a composite endpoint of cardiac death, MI and/or TVR.



中文翻译:

巨噬细胞数量和位置与临床结果的关系:气候研究的亚分析

背景

光学相干断层扫描 (OCT) 识别斑块内巨噬细胞浸润的能力现已得到广泛认可。这项 CLIMA 研究的事后分析旨在解决 OCT 定义的巨噬细胞周向延伸的临床影响及其在一年随访中的位置。

方法

多中心 CLIMA 研究招募了 1003 名接受 OCT 评估的未经治疗的近端左前降支 (LAD) 冠状动脉的患者。在被判断为含有最大量巨噬细胞的斑块横截面处进行巨噬细胞周向延伸的测量和从内膜腔轮廓到巨噬细胞串的距离的测量。主要研究终点是心源性死亡、心肌梗死 (MI) 和/或靶血管血运重建 (TVR) 的复合终点。

结果

具有大巨噬细胞弧 (p = 0.001) 和浅表巨噬细胞弧 (p < 0.001) 的患者显示主要的一年复合终点的一年发生率较高。高血压 (p = 0.018)、CAD 家族史 (p = 0.046)、糖尿病 (p = 0.036)、射血分数低 (p = 0.009) 和慢性肾病 (p = 0.019) 在经历过的患者中更常见主要复合终点。在多变量 Cox 回归分析中,纤维帽厚度 < 75 μm (HR 2.51, 95% 1.46–4.32),存在大 (HR 1.97, 95%CI 1.16–3.35, p = 0.012) 和浅表 (HR 1.72, 95%CI 1.02–2.90;p = 0.040)巨噬细胞弧仍然是主要复合终点的独立预测因子。大巨噬细胞弧与目标 LAD 相关 MI 相关。

结论

目前对 CLIMA 的事后分析表明,巨噬细胞的周向延伸及其位置与心源性死亡、MI 和/或 TVR 的复合终点有关。

更新日期:2021-11-17
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