COMBINE (OCT-FFR), combined fractional flow reserve (FFR) and optical coherence tomography (OCT) to improve the accuracy of identifying high-risk lesions in patients with diabetes. Patients with diabetes, who had non-culprit target lesion(s) with 40-80% diameter stenosis and negative FFR, underwent OCT to determine the presence or absence of TCFA (thin-capped fibroatheroma). The primary endpoint – incidence of non-culprit lesion related major adverse cardiac events – occurred in 13.3 percent of the thin-cap fibroatheroma (TCFA), group compared with 3.1 percent of the TCFA-negative group, P=0.0004.   This small trial is thought-provoking and, similar to the PROSPECT II trial, provides a basis for a future larger randomized controlled trial to evaluate whether medical or interventional therapies can mitigate the risk associated with the presence of “high risk” non-culprit lesions  

All Editors: David A. Cox, MD, MSCAI, Allison G. Dupont, MD, FSCAI, Kirk N. Garratt, MD, MSc, MSCAI, Cindy L. Grines, MD, MSCAI, Andrew J. Klein, MD, FSCAI, and Jordan Safirstein, MD, FSCAI.