The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Clinical outcomes of suboptimal stent deployment as assessed by optical coherence tomography: long-term results of the CLI-OPCI registry

DOI: 10.4244/EIJ-D-21-00627

1. Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Rome, Italy; 2. UniCamillus - Saint Camillus International University of Health Sciences, Rome, Italy; 3. Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy; 4. Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; 5. Sapienza University of Rome, Rome, Italy; 6. Cardio-Thoracic-Vascular Department, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy; 7. Centro Cardiologico Monzino, IRCCS, Milan, Italy; 8. Azienda Ospedaliera Universitaria Senese, Siena, Italy; 9. Cardiology Department, Santa Maria Goretti Hospital, Latina, Italy; 10. Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan; 11. Department of Cardiology, Hospital Universitario de La Princesa, Universidad Autónoma Madrid, CIBERCV, Madrid, Spain; 12. Cardiovascular Research Foundation, New York, NY, USA

Background: Intraprocedural optical coherence tomography (OCT) is a valuable tool for guidance of percutaneous coronary intervention, but long-term follow-up data are lacking.

Aims: The aim of this study was to address the long-term (7.5 years) clinical impact of quantitative OCT metrics of suboptimal stent implantation.

Methods: This retrospective study includes 391 patients with long-term follow-up (mean 2,737 days; interquartile range 1,301-3,143 days) from the multicentre Centro per la Lotta contro l’Infarto – Optimisation of Percutaneous Coronary Intervention (CLI-OPCI) registry. OCT-assessed suboptimal stent deployment required the presence of at least one of the following pre-defined OCT findings: in-stent MLA <4.5 mm2, proximal or distal reference lumen narrowing with lumen area <4.5 mm2, significant proximal or distal edge dissection width ≥200 μm.

Results: One-hundred-two patients (26.1%) with 138 stented lesions (27.7%) experienced a device-oriented cardiovascular event (DOCE). In-stent MLA <4.5 mm2 (38.1% vs 19.8%, p<0.001), in-stent lumen expansion <70% (29.5% vs 20.3%, p=0.032), proximal reference lumen narrowing <4.5 mm2 (6.5% vs 1.4%, p=0.004), and distal reference lumen narrowing <4.5 mm2 (12.9% vs 3.6%, p=0.001) were significantly more common in the DOCE vs non-DOCE group. OCT assessed suboptimal stent deployment was an independent predictor of long-term DOCE (HR 2.17, p<0.001), together with bare metal stent implantation (HR 1.73, p=0.003) and prior revascularisation (HR 1.53, p=0.017).

Conclusions: The presence of OCT assessed suboptimal criteria for stent implantation was related to a worse clinical outcome at very long-term follow-up. This information further supports an OCT-guided strategy of stent deployment.

Sign in to read and download the full article

Forgot your password?
No account yet? Sign up for free!
Create my pcr account

Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from PCRonline.com

Read next article
Percutaneous left atrial appendage closure in a surgically ligated left atrial appendage