AIMS The CLIMA study, on the relationship between coronary plaque morphology of the left anterior descending artery and twelve months clinical outcome, was designed to explore the predictive value of multiple high-risk plaque features in the same coronary lesion [minimum lumen area (MLA), fibrous cap thickness (FCT), lipid arc circumferential extension, and presence of optical coherence tomography (OCT)-defined macrophages] as detected by OCT. Composite of cardiac death and target segment myocardial infarction was the primary clinical endpoint. METHODS AND RESULTS From January 2013 to December 2016, 1003 patients undergoing OCT evaluation of the untreated proximal left anterior descending coronary artery in the context of clinically indicated coronary angiogram were prospectively enrolled at 11 independent centres (clinicaltrial.gov identifier NCT02883088). At 1-year, the primary clinical endpoint was observed in 37 patients (3.7%). In a total of 1776 lipid plaques, presence of MLA <3.5 mm2 [hazard ratio (HR) 2.1, 95% confidence interval (CI) 1.1-4.0], FCT <75 µm (HR 4.7, 95% CI 2.4-9.0), lipid arc circumferential extension >180° (HR 2.4, 95% CI 1.2-4.8), and OCT-defined macrophages (HR 2.7, 95% CI 1.2-6.1) were all associated with increased risk of the primary endpoint. The pre-specified combination of plaque features (simultaneous presence of the four OCT criteria in the same plaque) was observed in 18.9% of patients experiencing the primary endpoint and was an independent predictor of events (HR 7.54, 95% CI 3.1-18.6). CONCLUSION The simultaneous presence of four high-risk OCT plaque features was found to be associated with a higher risk of major coronary events.

中文翻译：

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左前降支冠状动脉斑块形态与 12 个月临床结局的关系：CLIMA 研究

目的 CLIMA 研究是关于左前降支冠状动脉斑块形态与 12 个月临床结果之间的关系，旨在探讨同一冠状动脉病变中多个高危斑块特征的预测价值 [最小管腔面积 (MLA) OCT 检测到的纤维帽厚度 (FCT)、脂质弧圆周延伸和光学相干断层扫描 (OCT) 定义的巨噬细胞的存在。心源性死亡和靶段心肌梗死的复合是主要的临床终点。方法和结果 从 2013 年 1 月到 2016 年 12 月，在有临床指征的冠状动脉造影的背景下，1003 名接受未经治疗的近端左前降支冠状动脉 OCT 评估的患者在 11 个独立中心（临床试验。政府标识符 NCT02883088）。在 1 年时，在 37 名患者 (3.7%) 中观察到主要临床终点。在总共 1776 个脂质斑块中，MLA <3.5 mm2 [风险比 (HR) 2.1，95% 置信区间 (CI) 1.1-4.0]，FCT <75 µm (HR 4.7，95% CI 2.4-9.0)，脂质弧圆周延伸 >180°（HR 2.4，95% CI 1.2-4.8）和 OCT 定义的巨噬细胞（HR 2.7，95% CI 1.2-6.1）都与主要终点风险增加有关。在 18.9% 的经历主要终点的患者中观察到预先指定的斑块特征组合（在同一斑块中同时存在四个 OCT 标准），并且是事件的独立预测因子（HR 7.54，95% CI 3.1-18.6） .