Coronary interventions

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

EuroIntervention 2022;18:e150-e157. DOI: 10.4244/EIJ-D-21-00627

Francesco Prati
Francesco Prati1,2,3, MD; Enrico Romagnoli3,4, MD, PhD; Flavio Giuseppe Biccirè1,3,5, MD; Francesco Burzotta4, MD, PhD; Alessio La Manna6, MD; Simone Budassi1,3, MD; Vito Ramazzotti1, MD; Mario Albertucci1,3, MD; Franco Fabbiocchi7, MD; Alessandro Sticchi2,3, MD; Carlo Trani4, MD; Giuseppe Calligaris7, MD; Massimo Fineschi8, MD; Francesco Versaci9, MD; Corrado Tamburino6, MD; Yukio Ozaki10, MD, PhD; Fernando Alfonso11, MD, PhD; Gary S. Mintz12, MD
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 and 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.

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bare metal stentdrug-eluting stentmiscellaneousoptical coherence tomography
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