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Clinical Impact of OCT Findings During PCI: The CLI-OPCI II Study.
- Source :
-
JACC. Cardiovascular imaging [JACC Cardiovasc Imaging] 2015 Nov; Vol. 8 (11), pp. 1297-305. - Publication Year :
- 2015
-
Abstract
- Objectives: The goal of this study was to assess the clinical impact of optical coherence tomography (OCT) findings during percutaneous coronary intervention (PCI).<br />Background: OCT provides unprecedented high-definition visualization of plaque/stent structures during PCI; however, the impact of OCT findings on outcome remains undefined.<br />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.<br />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 mm(2) (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 mm(2) 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).<br />Conclusions: Suboptimal stent deployment defined according to specific quantitative OCT criteria was associated with an increased risk of MACE during follow-up.<br /> (Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Chi-Square Distribution
Coronary Artery Disease mortality
Coronary Restenosis etiology
Coronary Restenosis pathology
Coronary Thrombosis etiology
Coronary Thrombosis pathology
Female
Humans
Italy
Kaplan-Meier Estimate
Logistic Models
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction etiology
Myocardial Infarction pathology
Predictive Value of Tests
Proportional Hazards Models
Registries
Retrospective Studies
Risk Factors
Stents
Time Factors
Treatment Outcome
Coronary Artery Disease pathology
Coronary Artery Disease therapy
Coronary Vessels pathology
Percutaneous Coronary Intervention adverse effects
Percutaneous Coronary Intervention instrumentation
Percutaneous Coronary Intervention mortality
Tomography, Optical Coherence
Subjects
Details
- Language :
- English
- ISSN :
- 1876-7591
- Volume :
- 8
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- JACC. Cardiovascular imaging
- Publication Type :
- Academic Journal
- Accession number :
- 26563859
- Full Text :
- https://doi.org/10.1016/j.jcmg.2015.08.013