Benefit of coronary stenting using available intracoronary tools in high-risk patients. The OPTI-XIENCE study

Abstract

Background: The clinical benefit of using ICT for coronary stent optimization remains uncertain in randomized trials, in which a unique ICT was used in most cases.

Aim: To assess the clinical impact of intracoronary techniques (ICT) for stent optimization in high-risk patients.

Methods: The OPTI-XIENCE study is a prospective, observational, multicenter international study including high-risk patients undergoing coronary stenting, in whom any ICT was used for stent optimization at the operator's discretion. The control group was the extended-risk cohort of the XIENCE V USA study, in which no ICT was used. The primary endpoint was the 1-year rate of target lesion failure (TLF), defined as a composite of cardiac death, target-vessel myocardial infarction, or ischemia-driven target lesion revascularization.

Results: 753 patients were included. The most frequently used ICT was optical coherence tomography (61.4 %), followed by intravascular ultrasound (22.5 %) and pressure wire in 163 (21.6 %). After propensity score matching with the XIENCE V USA cohort (n = 3179), 653 matched pairs were analyzed. The incidence of TLF at 1 year was significantly lower in the OPTI-XIENCE (3.4 % vs. 9.3 %, p < 0.001), driven by a reduction in target-vessel myocardial infarction (0.9 % vs. 5.6 %, p < 0.001) and ischemia-driven target lesion revascularization (1.1 % vs. 4.6 %, p < 0.001). The incidence of probable or definitive stent thrombosis at 1 year was 0.3 % vs 0.9 %, respectively (p = 0.154).

Conclusion: The use of any ICT for stent optimization in high-risk PCI significantly improves clinical outcomes compared to angiographic guidance alone. These findings support an individualized use of ICT to optimize complex PCI outcomes.

Keywords: Coronary physiology; Intracoronary imaging; Intravascular ultrasound; Optical coherence tomography; Percutaneous coronary intervention; Stent optimization.