Clinical Impact of OCT-Derived Suboptimal Stent Implantation Parameters and Definitions

Eur Heart J Cardiovasc Imaging. 2023 Jul 18:jead172. doi: 10.1093/ehjci/jead172. Online ahead of print.


Aims: Despite growing evidence supporting the clinical utility of optical coherence tomography (OCT)-guidance during percutaneous coronary interventions (PCIs), there is no common agreement as to the optimal stent implantation parameters that enhance clinical outcome.

Methods and results: We retrospectively examined the predictive accuracy of suboptimal stent implantation definitions proposed from the CLI-OPCI II, ILUMIEN-IV OPTIMAL PCI, and FORZA studies for the long-term risk of device oriented cardiovascular events (DoCE) in the population of large all-comers CLI-OPCI project.A total of 1020 patients undergoing OCT-guided drug-eluting stent implantation in the CLI-OPCI registry with a median follow-up of 809 (quartiles 414-1376) days constituted the study population. According to CLI-OPCI II, ILUMIEN-IV OPTIMAL PCI, and FORZA criteria, the incidence of suboptimal stent implantation was31.8%, 58.1%, and 57.8%, respectively. By multivariable Cox analysis, suboptimal stent implantation criteria from the CLI-OPCI II (hazard ratio 2.75 [95% confidence interval 1.88-4.02], p<0.001) and ILUMIEN-IV OPTIMAL PCI (1.79 [1.18-2.71], p=0.006) studies, but not FORZA trial (1.11 [0.75-1.63], p=0.597), were predictive of DoCE. At long-term follow-up, stent edge disease with minimum lumen area <4.5mm2 (8.17 [5.32-12.53], p<0.001), stent edge dissection (2.38 [1.33-4.27], p=0.004) and minimum stent area <4.5mm2 (1.68 [1.13-2.51], p=0.011) were the main OCT predictors of DoCE.

Conclusion: The clinical utility of OCT-guided PCI might depend on the metrics adopted to define suboptimal stent implantation. Uncovered disease at the stent border, stent edge dissection, and minimum stent area <4.5mm2 were the strongest OCT associates of stent failure.

Keywords: Drug-eluting stent; Optical coherence tomography; clinical research; risk stratification.