Combined fractional flow reserve (FFR) and optical coherence tomography (OCT) can improve the accuracy of predicting adverse event outcomes in patients with diabetes mellitus (DM), according to Elvin Kedhi, MD, presenting results from the COMBINE (OCT-FFR) trial Oct. 14 during TCT 2020.

As part of the trial, 500 DM patients with stable or acute coronary syndromes and who had ≥1 (non-culprit) target lesion with a 40-80% diameter stenosis underwent FFR assessment. FFR-negative patients underwent OCT assessment and were given further medical treatment. Patients were then divided into two groups depending on the presence (Group A) or absence of (Group B) a thin cap fibroatheroma (TCFA). Patients with FFR-positive target lesions were revascularized and placed in a third group (Group C). The primary endpoint was a composite of cardiac death, target-lesion myocardial infarction, clinically-driven target lesion revascularization or hospitalization due to unstable angina at 1.5 years between groups A and B.

COMBINE (OCT-FFR) showed for the first time that in patients with DM more than 25% of all FFR-negative lesions represent high-risk plaques, said Kedhi, who also noted that the presence of TCFA appears to be a strong predictor of future major adverse cardiac events, despite lack of ischemia. Additionally, Kedhi and colleagues observed that patients with TCFA had a significant increase in target-lesion-related major adverse cardiovascular events and myocardial infarction compared with patients without TCFA.

Kedhi, et al., note that their findings offer new insights into the treatment of DM patients who tend to have worse outcomes in terms of FFR-negative lesions compared with those without DM. They also suggest that “ischemia and future adverse events represent, to a large extent, two separate concepts,” and should be studied further.

Keywords: TCT20, Transcatheter Cardiovascular Therapeutics, Diabetes Mellitus, Fractional Flow Reserve, Myocardial

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