Synergy Between morpHOlogical and inflammatoRy Evaluation in Predicting Long-term Coronary Plaque Progression

Coronary Artery Disease Clinical Trial

— SHORE  

Official title:

Synergy Between morpHOlogical and inflammatoRy Evaluation in Predicting Long-term Coronary Plaque Progression

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT05436977
• Other study ID #: SHORE_Bo_2020
• Status: Active, not recruiting
• Phase: N/A
• Start date: June 21, 2021
• Est. completion date: June 21, 2024

Study information

• Verified date: May 2024
• Source: University of Bologna
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Data from human autopsy studies have showed that thrombosis of a ruptured plaque with a large necrotic core, inflammatory cells and a thin fibrous cap, the so-called thin cap fibroatheroma (TCFA), represents the main mechanism for acute coronary syndrome (ACS). Optical coherence tomography (OCT) is an imaging technique that provides high-resolution, cross-sectional images of tissue in situ. The resolution of OCT (10 um) is appropriate for measuring a cap thickness less than65 μm, and even the plaque macrophage density. 68Ga-DOTA-(Tyr3)-octreotate/NaI3-octreotide(68Ga-DOTA-TATE/NOC) Positron Emission Tomography (PET)/Computed Tomography coronary angiography (CTCA), targeting the somatostatin receptor subtype-2 selectively expressed by M1 macrophages may show coronary inflammation. The SHORE protocol aims at evaluating the synergy between OCT and 68Ga-DOTA-TATE/NOC in predicting coronary plaque progression as assessed by CTCA

Description:

ACS are the leading cause of mortality and morbidity in the western world. Despite recommended therapies, after experiencing an ACS episode patients still have an increased cardiovascular risk during follow up. In the CLIMA study OCT criteria of plaque vulnerability at non-culprit sites such as minimum luminal area <3.5mm2, fibrous cap thickness <75 µm, lipid arc extension >180° and macrophage infiltration was associated with an increased risk of cardiac death and myocardial infarction (HR 7.54, 95%CI 3.1-18.6).

Of the 36 OCT defined vulnerable plaques only 7 were associated with events showing a very low positive predictive value (19%). Yet, among the 577 plaques with macrophages accumulation only the 5.2% was associated with the endpoint. The lack of reliable information on plaque inflammation could represent the miss point to better link high risk plaques to plaque progression and/or rupture. Recent studies showed that inflammation in coronary plaques may be measured by means 68Ga-DOTATATE/PET targeting the somatostatin receptor subtype-2 selectively expressed by M1 macrophages.

Thus the investigators aim to evaluate the in vivo natural history of coronary plaques characterized from both the morphological (OCT) and inflammatory (68Ga-DOTATATE PET/CTCA) point of view in patients with ACS and at least 1 intermediated coronary lesion as assessed by FFR/iFR

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 40
• Est. completion date: June 21, 2024
• Est. primary completion date: June 21, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 50 Years and older

Eligibility

Inclusion Criteria:

• Male or female participants > 50 years old

• Able to give written, informed consent and to lie flat

• Presentation of ACS within ~2 weeks

• At least 1 intermediate (30-80% diameter stenosis) non-culprit coronary artery lesion on angiography, managed medically as clinically indicated (i.e.: negative FFR/iFR)

Exclusion Criteria:

• Women of child bearing potential not using adequate contraception

• Contrast allergy or contrast-nephropathy

• Uncontrolled atrial fibrillation

• Chronic kidney disease (eGFR <30 l/min/1.73m2)

• Uncontrolled chronic inflammatory disorder

• History of recent malignancy deemed relevant to the study by the investigator

• Current use of systemic corticosteroids

• Previous coronary artery bypass grafting surgery (CABG) or percutaneous coronary intervention (PCI) before the index event

• Contraindication to coronary angiography

• Requires CABG or staged non-culprit artery PCI

• Coronary vessels that could not be adequately imaged

• Severe valvular heart disease

• Any medical condition, in the opinion of the investigator, that prevents the participant from lying flat during scanning, or from participating in the study.

Related Conditions & MeSH terms

• Acute Coronary Syndrome
• Atherosclerosis
• Coronary Artery Disease
• Inflammation

Intervention

Diagnostic Test:
• coronary OCT
Intermediate coronary lesions will be evaluated by OCT
• 68GaDOTATATE PET/CTCA
Intermediate coronary lesions will be evaluated by68GaDOTATATE PET/CTCA

Locations

Country	Name	City	State
Italy	University of Bologna IRCCS Policlinico di St. Orsola	Bologna

Sponsors (3)

Lead Sponsor	Collaborator
University of Bologna	Centro per la Lotta Contro l'Infarto - Fondazione Onlus, University of Cambridge

Country where clinical trial is conducted

Italy, 

References & Publications (2)

Prati F, Romagnoli E, Gatto L, La Manna A, Burzotta F, Ozaki Y, Marco V, Boi A, Fineschi M, Fabbiocchi F, Taglieri N, Niccoli G, Trani C, Versaci F, Calligaris G, Ruscica G, Di Giorgio A, Vergallo R, Albertucci M, Biondi-Zoccai G, Tamburino C, Crea F, Alf — View Citation

Tarkin JM, Joshi FR, Evans NR, Chowdhury MM, Figg NL, Shah AV, Starks LT, Martin-Garrido A, Manavaki R, Yu E, Kuc RE, Grassi L, Kreuzhuber R, Kostadima MA, Frontini M, Kirkpatrick PJ, Coughlin PA, Gopalan D, Fryer TD, Buscombe JR, Groves AM, Ouwehand WH, — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Relationship between OCT and PET findings	Comparison of 68Ga-DOTANOC imaging to OCT assessed plaque morphology	baseline
Primary	Coronary Plaque Progression	Comparison of baseline non culprit OCT imaging and baseline 68Ga-DOTANOC tissue-to-blood ratio in patients with significant plaque progression measured by CTCA (defined by changes in low attenuation plaque volume and total atheroma volume), versus those without	2 years
Secondary	Coronary Plaque Progression	Comparison of baseline non culprit OCT imaging and 12 weeks 68Ga-DOTANOC tissue-to-blood ratio in patients with significant plaque progression measured at 2 years follow up by CTCA (defined by change in low attenuation plaque volume and total atheroma volume), versus those without	2 years