High prevalence of local coronary arterial inflammation in clinically stable subjects after myocardial infarction: findings from the FORTIFY trial screenees

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.