Back to Search
Start Over
Clinical Impact of Suboptimal Stenting and Residual Intrastent Plaque/Thrombus Protrusion in Patients With Acute Coronary Syndrome: The CLI-OPCI ACS Substudy (Centro per la Lotta Contro L'Infarto-Optimization of Percutaneous Coronary Intervention in Acute Coronary Syndrome).
- Source :
-
Circulation. Cardiovascular interventions [Circ Cardiovasc Interv] 2016 Dec; Vol. 9 (12). - Publication Year :
- 2016
-
Abstract
- Background: Clinical consequences of optical coherence tomographic (OCT) high-definition visualization of plaque/stent structures in acute patients remain undefined. In this retrospective substudy, we assessed the prognostic impact of postprocedural culprit lesion OCT findings in patients with acute coronary syndrome undergoing percutaneous coronary intervention.<br />Methods and Results: In the CLI-OPCI (Centro per la Lotta Contro L'Infarto-Optimization of Percutaneous Coronary Intervention) database collecting cases from 5 independent OCT-experienced centers, we retrospectively analyzed postprocedural OCT findings in acute coronary syndrome patients and explored its possible impact (specifically that of residual intrastent plaque/thrombus protrusion) on outcome. From 2009 to 2013, 507 patients (588 lesions) were evaluated. Patients experiencing device-oriented cardiovascular events showed more frequently the features of suboptimal stent implantation defined as the presence of significant residual intrastent plaque/thrombus protrusion (hazard ratio [HR], 2.35; P<0.01), in-stent minimum lumen area (MLA) <4.5 mm <superscript>2</superscript> (HR, 2.72; P<0.01), dissection >200 µm at distal stent edge (HR, 3.84; P<0.01), and reference lumen area <4.5 mm <superscript>2</superscript> at either distal (HR, 6.07; P<0.001) or proximal (HR, 8.50; P<0.001) stent edges. Postprocedural OCT assessment of treated culprit lesion revealed at least one of these parameters in 55.2% of cases, with an associated increased risk of device-oriented cardiovascular events during follow-up (17.9% versus 4.8%; P<0.001). Both the presence of at least one of these parameters (HR, 3.69; P=0.002) and the residual intrastent plaque/thrombus protrusion (HR, 2.83; P=0.008) were confirmed as independent predictors of device-oriented cardiovascular events.<br />Conclusions: In this retrospective study of acute coronary syndrome patients undergoing percutaneous coronary intervention, a composite of OCT-defined suboptimal stent implantation characteristics at the culprit lesion and residual intrastent plaque/thrombus protrusion was associated with adverse outcome.<br /> (© 2016 American Heart Association, Inc.)
- Subjects :
- Acute Coronary Syndrome diagnostic imaging
Aged
Coronary Thrombosis diagnostic imaging
Databases, Factual
Disease-Free Survival
Female
Humans
Italy
Kaplan-Meier Estimate
Male
Middle Aged
Percutaneous Coronary Intervention adverse effects
Predictive Value of Tests
Proportional Hazards Models
Registries
Retrospective Studies
Risk Factors
Time Factors
Tomography, Optical Coherence
Treatment Outcome
Acute Coronary Syndrome therapy
Coronary Thrombosis therapy
Coronary Vessels diagnostic imaging
Percutaneous Coronary Intervention instrumentation
Plaque, Atherosclerotic
Stents
Subjects
Details
- Language :
- English
- ISSN :
- 1941-7632
- Volume :
- 9
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Circulation. Cardiovascular interventions
- Publication Type :
- Academic Journal
- Accession number :
- 27965297
- Full Text :
- https://doi.org/10.1161/CIRCINTERVENTIONS.115.003726