Clinical Impact of OCT Findings During PCI: The CLI-OPCI II Study

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• 作者：Francesco Prati ; MD ; PhD^&lowast ; ; ^&dagger ; ; ^{fprati@hsangiovanni.roma.it" class="auth_mail" title="E-mail the corresponding author} ; Enrico Romagnoli ; MD ; PhD^&dagger ; ; Francesco Burzotta ; MD ; PhD^&Dagger ; ; Ugo Limbruno ; MD^§ ; ; Laura Gatto ; MD^&lowast ; ; ^&dagger ; ; Alessio La Manna ; MD^‖ ; Francesco Versaci ; MD^¶ ; ; Valeria Marco ; RN^&dagger ; ; Luca Di Vito ; MD ; PhD^&lowast ; ; Fabrizio Imola ; MD^&lowast ; ; Giulia Paoletti ; RN^&dagger ; ; Carlo Trani ; MD^&Dagger ; ; Corrado Tamburino ; MD^‖ ; Luigi Tavazzi ; MD^# ; Gary S. Mintz ; MD^&lowast ; &lowast ;
• 关键词：clinical outcome ; optical coherence tomography ; percutaneous coronary intervention ; registry
• 刊名：JACC: Cardiovascular Imaging
• 出版年：2015
• 出版时间：November 2015
• 年：2015
• 卷：8
• 期：11
• 页码：1297-1305
• 全文大小：683 K

文摘

The goal of this study was to assess the clinical impact of optical coherence tomography (OCT) findings during percutaneous coronary intervention (PCI).

Background

OCT provides unprecedented high-definition visualization of plaque/stent structures during PCI; however, the impact of OCT findings on outcome remains undefined.

Methods

In the context of the multicenter CLI-OPCI (Centro per la Lotta contro l’Infarto–Optimisation of Percutaneous Coronary Intervention) registry, we retrospectively analyzed patients undergoing end-procedural OCT assessment and compared the findings with clinical outcomes.

Results

A total of 1,002 lesions (832 patients) were assessed. Appropriate OCT assessment was obtained in 98.2% of cases and revealed suboptimal stent implantation in 31.0% of lesions, with increased incidence in patients experiencing major adverse cardiac events (MACE) during follow-up (59.2% vs. 26.9%; p < 0.001). In particular, in-stent minimum lumen area <4.5 mm² (hazards ratio [HR]: 1.64; p = 0.040), dissection >200 μm at the distal stent edge (HR: 2.54; p = 0.004), and reference lumen area <4.5 mm² at either distal (HR: 4.65; p < 0.001) or proximal (HR: 5.73; p < 0.001) stent edges were independent predictors of MACE. Conversely, in-stent minimum lumen area/mean reference lumen area <70% (HR: 1.21; p = 0.45), stent malapposition >200 μm (HR: 1.15; p = 0.52), intrastent plaque/thrombus protrusion >500 μm (HR: 1.00; p = 0.99), and dissection >200 μm at the proximal stent edge (HR: 0.83; p = 0.65) were not associated with worse outcomes. Using multivariable Cox hazard analysis, the presence of at least 1 significant criterion for suboptimal OCT stent deployment was confirmed as an independent predictor of MACE (HR: 3.53; 95% confidence interval: 2.2 to 5.8; p < 0.001).

Conclusions

Suboptimal stent deployment defined according to specific quantitative OCT criteria was associated with an increased risk of MACE during follow-up.