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

Relationship between stent expansion and post-PCI  fractional flow reserve: a DOCTORS sub study

DOI: 10.4244/EIJ-D-19-01103

1. Department of Cardiology, Institut Mutualiste Montsouris, Paris, France, France
2. Department of Cardiology, EA3920, University Hospital Jean Minjoz, Besançon, France
3. Department of Cardiology, University Hospital Gabriel Montpied, and Université d’Auvergne UMR 6284, Clermont Ferrand, France
4. Department of Cardiology, Nouvel Hôpital Civil, Strasbourg, France
5. Sorbonne université , ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), INSERM UMR-S 1166, ICAN, Paris, France
6. Department of Cardiology, Centre Hospitalier, Chambéry, France
7. Department of Cardiology, Centre Hospitalier, Belfort, France

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Aims: To analyse the relationship between stent expansion criteria using optical coherence tomography (OCT) analysis and the final PCI functional result. 

Methods & Results: This post-hoc analysis of the DOCTORS study included non-ST elevation segment ACS patients undergoing OCT-guided PCI. The procedure functional result was assessed by the measurement of fractional flow reserve (FFR). Stent expansion was assessed on OCT runs according to the DOCTORS criteria and ILUMIEN-III criteria. 

The study included N=116 patients (Age: 60.8±11.5 years/ male gender:71%). The final expansion was considered optimal in 10%, acceptable in 9% and unacceptable in 81% of the stents according to ILUMIEN-III criteria, although being successful in 70% of the patients according to the DOCTORS criteria. Hypertension and larger proximal reference segment dimension were independent predictors of inadequate device ILUMIEN-III expansion. FFR values were respectively 0.930.91-0.95 vs. 0.950.92-0.97 in patients with optimal+ acceptable vs. unacceptable ILUMIEN-III expansion (p=0.22), 0.940.91-0.97 vs. 0.95 0.93-0.97 in patients with optimal vs. non-optimal DOCTORS expansion (p=0.23) and 0.950.92-0.97 vs. 0.920.90-0.95 in patients with minimal stent area 4.5 mm2 vs. <4.5 mm2 (p=0.03). 

Conclusions: In this selected population, no relationship was observed between optimal stent expansion according to ILUMIEN-III or DOCTORS OCT criteria and final post-PCI FFR values.

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