PMID- 36534217 OWN - NLM STAT- MEDLINE DCOM- 20230418 LR - 20230418 IS - 1875-8312 (Electronic) IS - 1569-5794 (Linking) VI - 39 IP - 4 DP - 2023 Apr TI - Sex-specific features of optical coherence tomography detected plaque vulnerability related to clinical outcomes: insights from the CLIMA study. PG - 873-881 LID - 10.1007/s10554-022-02775-w [doi] AB - PURPOSE: To investigate the different impact of optical coherence tomography (OCT)-derived vulnerable plaque features on future adverse events (AEs) according to the biological sex. METHODS: The prospective multicenter CLIMA study (ClinicalTrials.gov: NCT02883088) enrolled 1003 patients with OCT plaque analysis of non-treated coronary plaques located in the proximal left anterior descending artery. Sex-specific differences in plaque composition and vulnerable features were described. We investigated the incidence of AEs, including cardiac death, any myocardial infarction and target vessel revascularization at 1-year. RESULTS: Among 1003 patients, 24.6% were women. Women were older and more frequently affected by chronic kidney disease. Dyslipidemia, prior MI and smoking habit were more common in men. At OCT analysis, women had shorter plaque length (p < 0.001), ticker fibrous cap (p = 0.001), smaller maximum lipid arc (p = 0.019), lower macrophage infiltration (p < 0.001) and intra-plaque layered tissue (p = 0.007). During follow-up, 65 AEs were registered. The presence of a thin fibrous cap and a large macrophage infiltration (> 67 degrees ) predicted AEs in both sexes. The presence of macrophages (HR 3.38, p = 0.018) and a small minimum lumen area (HR 4.97, p = 0.002) were associated with AEs in women but not in men, while a large lipid arc (> 180 degrees ) was associated with AEs in men (HR 2.56, p = 0.003) but not in women. CONCLUSION: This subanalysis of the CLIMA study investigated for the first-time sex-specific OCT features of plaque vulnerability associated with AEs. Local inflammation was associated with AEs in women and a large lipid arc was predictive in men. OCT may help develop sex-specific risk stratification strategies. CI - (c) 2022. The Author(s), under exclusive licence to Springer Nature B.V. FAU - Biccire, Flavio Giuseppe AU - Biccire FG AD - Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy. AD - Sapienza University of Rome, Rome, Italy. FAU - Debelak, Caterina AU - Debelak C AD - Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy. FAU - Varricchione, Giuseppe AU - Varricchione G AD - Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy. AD - Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Rome, Italy. AD - Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy. FAU - Budassi, Simone AU - Budassi S AD - Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy. AD - Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Rome, Italy. FAU - Gatto, Laura AU - Gatto L AD - Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy. AD - Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Rome, Italy. FAU - Romagnoli, Enrico AU - Romagnoli E AD - Departement of Cardiovascular and Thoracic Sciences, Universita Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy. FAU - Di Pietro, Riccardo AU - Di Pietro R AD - Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy. AD - Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Rome, Italy. FAU - Sammartini, Emanuele AU - Sammartini E AD - Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy. FAU - Marco, Valeria AU - Marco V AD - Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy. FAU - Paoletti, Giulia AU - Paoletti G AD - Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy. AD - UniCamillus - Saint Camillus International University of Health Sciences, Rome, Italy. FAU - Burzotta, Francesco AU - Burzotta F AD - Departement of Cardiovascular and Thoracic Sciences, Universita Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy. FAU - Ozaki, Yukio AU - Ozaki Y AD - Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan. FAU - Pastori, Daniele AU - Pastori D AD - Sapienza University of Rome, Rome, Italy. FAU - Alfonso, Fernando AU - Alfonso F AD - Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain. FAU - Arbustini, Eloisa AU - Arbustini E AD - Centre for Inherited Cardiovascular Diseases, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy. FAU - Prati, Francesco AU - Prati F AD - Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy. fprati@hsangiovanni.roma.it. AD - Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Rome, Italy. fprati@hsangiovanni.roma.it. AD - UniCamillus - Saint Camillus International University of Health Sciences, Rome, Italy. fprati@hsangiovanni.roma.it. AD - Cardiovascular Department Interventional Cardiology Unit, San Giovanni Addolorata Hospital, Via dell'Amba Aradam, 8, 00184, Rome, Italy. fprati@hsangiovanni.roma.it. LA - eng SI - ClinicalTrials.gov/NCT02883088 PT - Journal Article PT - Multicenter Study DEP - 20221219 PL - United States TA - Int J Cardiovasc Imaging JT - The international journal of cardiovascular imaging JID - 100969716 RN - 0 (Lipids) SB - IM MH - Male MH - Humans MH - Female MH - Prospective Studies MH - Tomography, Optical Coherence/methods MH - Predictive Value of Tests MH - *Plaque, Atherosclerotic/pathology MH - Fibrosis MH - Lipids MH - *Coronary Artery Disease/diagnostic imaging/pathology MH - Coronary Vessels/diagnostic imaging/pathology MH - Coronary Angiography/methods OTO - NOTNLM OT - Cardiovascular risk OT - Gender differences OT - Optical coherence tomography OT - Prognosis OT - Sex differences OT - Vulnerable plaque EDAT- 2022/12/20 06:00 MHDA- 2023/04/18 10:16 CRDT- 2022/12/19 11:17 PHST- 2022/09/14 00:00 [received] PHST- 2022/12/06 00:00 [accepted] PHST- 2023/04/18 10:16 [medline] PHST- 2022/12/20 06:00 [pubmed] PHST- 2022/12/19 11:17 [entrez] AID - 10.1007/s10554-022-02775-w [pii] AID - 10.1007/s10554-022-02775-w [doi] PST - ppublish SO - Int J Cardiovasc Imaging. 2023 Apr;39(4):873-881. doi: 10.1007/s10554-022-02775-w. Epub 2022 Dec 19.