Optical coherence tomography-derived lipid core burden index and clinical outcomes: results from the CLIMA registry

Aims The aim of this study was to assess the morphological characteristics and prognostic implications of the optical coherence tomography (OCT)-derived lipid core burden index (LCBI). Methods OCT-LCBI was assessed in 1003 patients with 1-year follow-up from the CLIMA multicentre registry using a validated and results software able to automatically obtain a maximum OCT-LCBI in 4 mm (maxOCT-LCBI_4mm). Primary composite clinical endpoint included cardiac death, myocardial infarction, and target-vessel revascularization. A secondary analysis using clinical outcomes of CLIMA study was performed. Patients with a maxOCT-LCBI_4mm ≥ 400 showed higher prevalence of fibrous cap thickness (FCT),75 μm [odds ratio (OR) 1.43, 95% confidence interval (CI) 1.03–1.99; P= 0.034], lipid pool arc .180° (OR 3.93, 95%CI 2.97–5.21; P, 0.001), minimum lumen area,3.5 mm² (OR 1.5, 95%CI 1.16–1.94; P= 0.002), macrophage infiltration (OR 2.38, 95%CI 1.81–3.13; P, 0.001), and intra-plaque intimal vasculature (OR 1.34, 95%CI 1.05–1.72; P= 0.021). A maxOCT-LCBI_4mm ≥400 predicted the primary endpoint [adjusted hazard ratio (HR) 1.86, 95%CI 1.1–3.2; P= 0.019] as well as the CLIMA endpoint (HR 2.56, 95%CI 1.24–5.29; P= 0.011). Patients with high lipid content and thin FCT, 75 µm were at higher risk for adverse events (HR 4.88, 95%CI 2.44–9.72; P, 0.001). Conclusions A high maxOCT-LCBI_4mm was related to poor outcome and vulnerable plaque features. This study represents a step further in the automated assessment of the coronary plaque risk profile.