Suboptimal stent deployment defined according to specific quantitative OCT criteria was associated with an increased risk of MACE during follow-up.

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.

In spite of potent pro-inflammatory, pro-oxidant and pro-thrombotic stimuli operating in type II diabetes, diabetic patients exhibit substantially more severe coronary atherosclerosis than non-diabetic patients at the time of a first acute coronary event. Better collateral development towards the culprit vessel, a predominantly calcific plaque phenotype and, probably, yet unknown protective factors operating in diabetic patients may explain these intriguing paradoxical findings.

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The hypothesis that the Poincaré plot indexes of heart rate variability (HRV) detect dynamic changes after haemodialysis (HD) over the HRV in haemodynamically stable chronic renal failure (CRF) patients was examined. Minor axis (SD1), major axis (SD2) and the SD1/SD2 ratio were compared against standard HRV indexes in time and frequency domain, in a group of healthy subjects and in a group of CRF patients before and after HD. These indexes were estimated from Poincaré plots reconstructed with lags of one, two and four heartbeats. The surrogate data analysis technique was applied in order to discern if only random components or linear features of HRV contribute to its dynamics. None of the standard linear HRV indexes changed after HD. The Poincaré plot indexes measured from CRF patients were smaller than the ones measured from healthy subjects. In CRF patients the SD1/SD2 ratio decreased after HD, when a lag of four heartbeats was used (0.68 +/- 0.19 before HD versus 0.55 +/- 0.12 after HD, P<0.05). The presence of deterministic components in HRV were confirmed for all measures of the SD1/SD2 ratio. Moreover, a loss of non-linear components after HD was detected by the surrogate analysis over the SD1/SD2 ratio with a lag of four heartbeats. In conclusion, the SD1/SD2 ratio measured at lag of 4 heartbeats capture dynamic changes after HD upon the HRV of CRF patients that are not solely related to linear autocorrelations of HRV. This suggests that the SD1/SD2 ratio reflects non-linear information of HRV.