Optical coherence tomography-guided stent optimization for complex coronary lesions: the OCCUPI trial.

Area of Science:

• Interventional Cardiology
• Medical Imaging
• Vascular Biology

Background:

• Optical coherence tomography (OCT) guided percutaneous coronary intervention (PCI) is increasingly used for complex coronary lesions.
• Stent optimization is crucial for favorable outcomes, but determinants and clinical impact require further evaluation.
• The OCCUPI-OCT criteria provide a framework for assessing stent optimization post-PCI.

Purpose of the Study:

• To evaluate the incidence, determinants, and clinical impact of stent optimization after OCT-guided PCI for complex coronary lesions.
• To identify predictors of suboptimal stent placement.
• To assess the association between stent optimization and clinical outcomes.

Main Methods:

• Analysis of patients from the OCCUPI randomized trial who underwent OCT-guided PCI.
• Classification into OCT Optimization and OCT Sub-Optimization groups based on OCCUPI-OCT criteria.
• Primary endpoint: cumulative incidence of major adverse cardiac events at one year.

Main Results:

• 71.0% of patients achieved OCT Optimization; 29.0% had OCT Sub-Optimization.
• Long lesions and small-vessel disease were independent predictors of OCT Sub-Optimization.
• OCT Optimization was associated with significantly lower rates of major adverse cardiac events (2.9% vs. 9.4% for sub-optimization and 7.5% for angiography guidance).

Conclusions:

• Stent optimization following OCT-guided PCI is achievable in a majority of complex lesions.
• Long lesions and small-vessel disease are key determinants of suboptimal stent placement.
• Achieving optimal stent expansion, apposition, and minimizing edge dissection are critical for favorable clinical outcomes.