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. 2023 Dec 21;25(1):48-57.
doi: 10.1093/ehjci/jead172.

Clinical impact of OCT-derived suboptimal stent implantation parameters and definitions

Enrico Romagnoli  1 , Francesco Burzotta  1   2 , Rocco Vergallo  1 , Laura Gatto  3   4 , Giuseppe Biondi-Zoccai  5   6 , Vito Ramazzotti  3 , Flavio Biccirè  3   4 , Simone Budassi  3   4 , Carlo Trani  2 , Ziad Ali  7   8 , Gregg W Stone  9 , Francesco Prati  3   4   10
Affiliations

Clinical impact of OCT-derived suboptimal stent implantation parameters and definitions

Enrico Romagnoli et al. Eur Heart J Cardiovasc Imaging. .

Abstract

Aims: Despite growing evidence supporting the clinical utility of optical coherence tomography (OCT) guidance during percutaneous coronary interventions (PCIs), there is no common agreement as to the optimal stent implantation parameters that enhance clinical outcome.

Methods and results: We retrospectively examined the predictive accuracy of suboptimal stent implantation definitions proposed from the CLI-OPCI II, ILUMIEN-IV OPTIMAL PCI, and FORZA studies for the long-term risk of device-oriented cardiovascular events (DoCE) in the population of large all-comers CLI-OPCI project. A total of 1020 patients undergoing OCT-guided drug-eluting stent implantation in the CLI-OPCI registry with a median follow-up of 809 (quartiles 414-1376) days constituted the study population. According to CLI-OPCI II, ILUMIEN-IV OPTIMAL PCI, and FORZA criteria, the incidence of suboptimal stent implantation was 31.8%, 58.1%, and 57.8%, respectively. By multivariable Cox analysis, suboptimal stent implantation criteria from the CLI-OPCI II [hazard ratio 2.75 (95% confidence interval 1.88-4.02), P < 0.001] and ILUMIEN-IV OPTIMAL PCI [1.79 (1.18-2.71), P = 0.006] studies, but not FORZA trial [1.11 (0.75-1.63), P = 0.597], were predictive of DoCE. At long-term follow-up, stent edge disease with minimum lumen area <4.5 mm2 [8.17 (5.32-12.53), P < 0.001], stent edge dissection [2.38 (1.33-4.27), P = 0.004], and minimum stent area <4.5 mm2 [1.68 (1.13-2.51), P = 0.011] were the main OCT predictors of DoCE.

Conclusion: The clinical utility of OCT-guided PCI might depend on the metrics adopted to define suboptimal stent implantation. Uncovered disease at the stent border, stent edge dissection, and minimum stent area <4.5 mm2 were the strongest OCT associates of stent failure.

Keywords: clinical research; drug-eluting stent; optical coherence tomography; risk stratification.

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Conflict of interest statement

Conflict of interest: G.B.-Z. has consulted for Cardionovum, CrannMedical, InnovHeart, Meditrial, Opsens Medical, and Replycare. G.W.S. has received speaker or other honoraria from Cook and Infraredx; has served as a consultant to Valfix, TherOx, Robocath, HeartFlow, Ablative Solutions, Vectorious, Miracor, Neovasc, Abiomed, Ancora, Elucid Bio, Occlutech, CorFlow, Apollo Therapeutics, Impulse Dynamics, Reva, Vascular Dynamics, Shockwave, V-Wave, Cardiomech, and Gore; and has equity/options from Ancora, Cagent, Applied Therapeutics, Biostar family of funds, SpectraWave, Orchestra Biomed, Aria, Cardiac Success, Valfix, and MedFocus family of funds.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
Predictive hazards of all OCT parameters tested in the CLI-OPCI II, ILUMIEN-IV OPTIMAL PCI, and FORZA studies.
Figure 3
Figure 3
Clinical outcomes of suboptimal (full lines) and optimal stent implantation (dotted lines) as defined according to CLI-OPCI II, ILUMIEN-IV OPTIMAL PCI, and FORZA criteria.
Figure 4
Figure 4
Time-to-event curves for individual device-oriented cardiovascular events (DoCE) components in patients with (full lines) and without (dotted lines) suboptimal stent implantation according to the different study protocols.
Figure 5
Figure 5
DoCE incidence according to the different definitions of suboptimal stent implantation proposed in the CLI-OPCI II, ILUMIEN-IV OPTIMAL PCI, and FORZA studies.
Figure 6
Figure 6
End-procedural OCT findings associated with DES failure.
See this image and copyright information in PMC

References

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