Suboptimal Stent Deployment Using Optical Coherence Tomography May Increase Adverse Cardiac Events

Suboptimal stent deployment using optical coherence tomography (OCT) criteria caused an increased risk of major adverse cardiac events (MACE) during follow-up, according to the Journal of the American College of Cardiology.

OCT is a new technique designed to provide high-definition images of intraluminal and endothelial structures. Even with the higher quality visualization, the clinical use of this technique during a percutaneous coronary intervention (PCI), and the follow-up cardiac outcomes of the procedure are undetermined.

“The main finding provided by this large multicenter registry was that patients exhibiting suboptimal stent deployment on the basis of specific OCT criteria experienced a higher rate of MACE during follow-up,” the authors wrote. “Indeed, suboptimal stent was significantly more common in the MACE group (59.2% vs 26.9%; P<.001) and was found to be an independent predictor of MACE.”

The researchers examined 1002 lesions from 832 patients from the Centro per la Lotta contro l’Infarto-Optimisation of Percutaneous Coronary Intervention (CLI-OPCI) study. All participants underwent an end-procedural OCT assessment, which researchers compared to clinical outcomes.

Assessments showed suboptimal stent implantation in 31% (hazard ratio [HR]: 7.17; P=.001)of the legions. The OCT showed in-stent minimum lumen area (MLA) of <4.5 mm² in 23.4% (P<.001) of stented lesions. There was also evidence of edge dissection in 12.7% (P=.013) of lesions, in-stent lumen underexpansion in 23.7% (P=.07), malapposition in 49.3% (P=.85), intrastent plaque/thrombus protrusion (HR: 1.00; P=.83) in 29.4%, and reference lumen narrowing in 7.5% (P<.001).

After a 319-day median follow-up period, the data revealed a 12.6% MACE rate with 2.9% all-cause mortality, 7.7% caused by nonfatal myocardial infarction (MI), and 6.7% caused by target lesion revascularization.

Data showed that 82% of adverse events occurred within the first 12 months after the procedure. Patients with MACE during the follow-up had a lower left ventricular ejection fraction of 52% compared with 55% for patients who did not experience a cardiac event.  Patients with MACE also had more frequent NSTEMI diagnoses (19.1% vs 7.7%; P<.001), a higher rate of MI (32.4% vs 17.9%; P<.001)), and a higher rate of multivessel disease (65.7% vs 50.8%; P=.024).

Patients with MACE was associated with more bare metal stent (BMS) use during the procedure (34.4% vs 20.0%; P=.002), more treatment of a left main (9.6% vs 4.1%; P=.012), ostial lesion (8.8% vs 4.8%; P=.048), angiographically ambiguous lesion (13.6% vs 8.0%; P=.023), or in-stent restenosis lesion (7.2% vs 3.3%; P=.045).

There was also a significantly higher incidence rate of suboptimal stent deployment in lesions associated with an adverse event (59.2% vs 26.9%; P<.001).

“Stented segments exhibiting a narrowing at the reference lumen area <4.5 mm² in the presence of significant plaque experienced a worse outcome, with the risk of MACE approximately 5 times higher regardless of the location,” the authors noted.

According to the researchers, data were not unexpected because plaque burden identified by intravascular ultrasound at stent margins represents a well-known risk factor for late restenosis and thrombosis. OCT treatment and reformability require additional research because some OCT findings suggest poor cardiac outcome, they concluded.

Reference

1. Prati F, Romagnoli E, Burzotta F, et al. Clinical Impact of OCT Findings During PCI: The CLI-OPCI II Study. J Am Coll Cardiol. 2015;8(11):1297-1305. doi: 10.1016/j.jcmg.2015.08.013.