High prevalence of local coronary arterial inflammation in clinically stable subjects after myocardial infarction: findings from the FORTIFY trial screenees
T Villines, C Farina, W Lu, A Gille, K Melvin, C Shirodaria, C Antoniades, J Nilsson, P LibbyAbstract
Background
Coronary atheroma inflammation contributes to recurrent major adverse cardiovascular events (MACE) after myocardial infarction (MI). The prevalence of residual local coronary inflammation in clinically stable post-MI patients with well-controlled traditional risk factors is unknown. We assessed coronary inflammation using CCTA- derived FAI-Score in FORTIFY trial screenees.
Methods
FORTIFY is a phase 2b, randomized, double-blind, placebo-controlled, multicenter trial, evaluating orticumab in post-MI participants with elevated coronary inflammation. Orticumab is a first-in-class human monoclonal antibody targeting an oxidized low-density lipoprotein (oxLDL) epitope, intended to act locally in atheromata to reduce inflammation. Coronary inflammation was measured using the fat attenuation index (FAI)-Score derived from coronary computed tomographic angiography (CCTA). Eligible participants were clinically stable adults with prior MI (≥6 months), well-controlled traditional risk factors (including low-density lipoprotein cholesterol (LDL-C), blood pressure and glycemia), and stable, guideline-based secondary prevention therapy.
Results
As of Feb 6, 2026, 147 participants across 41 sites underwent screening by FAI-Score. Mean age was 63 years, and 15% were female. Median time from MI was 2.7 years (interquartile range [IQR] 1.2 – 5.1). Lipids including total cholesterol, LDL-C, HDL-C and triglyceride were largely within guideline-mandated ranges for secondary prevention. Median LDL-C was 1.5 mmol/L (IQR 1.2-1.9). Systolic and diastolic blood pressure were 126 (IQR 122-137) and 78 (IQR 71-86), respectively. Median HbA1c was 5.9% (IQR 5.6-6.2). Despite this, FAI-Score centiles were widely distributed and frequently elevated (Figure 1). Overall, 70% of screened subjects had ≥1 artery with a FAI-Score ≥50th centile and 36% had ≥1 artery with a FAI-Score ≥75th centile, a level that portends elevated MACE risk.
Conclusion
In clinically stable post-MI patients with well-controlled traditional risk factors, residual coronary inflammation assessed by FAI-Score appears common, despite low risk LDL-C concentrations, and spans a wide range, with many exhibiting high-inflammation. FORTIFY will assess whether adding orticumab to post-MI standard of care will further reduce coronary inflammation (FAI-Score) in randomized participants with high residual coronary inflammation.ESC2026 - Baseline Characteristic