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Stent Optimization Using Optical Coherence Tomography and Its Prognostic Implications After Percutaneous Coronary

Himanshu Rai1,2,3, Fiona Harzer1, Tatsuhiko Otsuka4

  • 1Klinik für Herz- und KreislauferkrankungenDeutsches Herzzentrum MünchenTechnische Universität München Munich Germany.

Journal of the American Heart Association
|April 26, 2022
PubMed
Summary

A stent expansion index (SEI) below 0.85, assessed by optical coherence tomography, predicts higher rates of major adverse cardiac events (MACE). This finding offers a crucial threshold for optimizing coronary stenting outcomes.

Keywords:
major adverse cardiac eventsoptical coherence tomographypercutaneous coronary interventionstent expansion index

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Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Medical Imaging

Background:

  • Stent underexpansion is a known risk factor for adverse cardiovascular outcomes.
  • Optical coherence tomography (OCT) is an advanced imaging modality used in percutaneous coronary interventions.

Purpose of the Study:

  • To define an optimal stent expansion index (SEI) using OCT that correlates with reduced major adverse cardiac events (MACE).
  • To establish a predictive cutoff value for SEI to guide clinical practice and improve patient outcomes.

Main Methods:

  • Retrospective analysis of 315 patients (370 lesions) undergoing OCT-guided coronary stenting.
  • SEI calculated as the minimum stent area divided by the mean reference lumen area, using the lesser value of two segments.
  • Follow-up MACE defined as a composite of death, myocardial infarction, stent thrombosis, and target lesion revascularization.

Main Results:

  • An SEI cutoff of <0.85 was identified as optimal for predicting MACE (Area Under Curve = 0.60).
  • Lesions with SEI <0.85 had a significantly higher incidence of MACE (15.4%) compared to those with SEI ≥0.85 (6.4%, P=0.02).
  • Suboptimal SEI (<0.85) and coronary calcification were independent predictors of follow-up MACE.

Conclusions:

  • An SEI <0.85 is associated with an increased incidence of MACE, serving as an optimal cutoff in clinical practice.
  • Coronary calcification, in addition to suboptimal SEI, is a significant predictor of adverse cardiac events post-stenting.