Clinical Impact and Lesion Characteristics of Suboptimal Optical Coherence Tomography Stent Deployment in Patients...

Suboptimal stent deployment detected by optical coherence tomography (OCT) correlates with adverse outcomes, yet its long-term prognosis and associations with lesion characteristics in patients with acute myocardial infarction (MI) receiving drug-eluting stents remain unclear. This study aimed to investigate the impact of OCT-defined stent parameters on long-term outcomes and identify lesion features predictive of suboptimal stent deployment in patients with acute MI.

Between January 2018 and December 2020, patients with acute MI undergoing successful intervention with drug-eluting stents and postprocedural OCT imaging at the target lesions were included. The end point was device-oriented cardiovascular events, a composite of cardiac death, target-vessel related MI, and target-lesion revascularization. Suboptimal OCT stent deployment was defined as the presence of ≥1 OCT findings significantly associated with device-oriented cardiovascular events. In a subgroup with preprocedural OCT imaging for target lesions, lesion morphology was assessed.

Among 881 patients (906 lesions with final OCT imaging), minimum stent area<4.5 mm², irregular protrusion, and distal reference lumen narrowing were independent predictors of device failure, at a median follow-up of 4.0 years. Patients with suboptimal OCT stent deployment had a higher incidence of device-oriented cardiovascular events, which was primarily driven by cardiac death and target lesion revascularization. In the subgroup (including 789 lesions), multivariate analysis identified plaque rupture, cholesterol crystals, and smaller reference lumen area as predictors of suboptimal OCT stent deployment.

Suboptimal stent deployment, defined by specific quantitative OCT criteria, was associated with device failure at long-term follow-up in patients with acute MI successfully treated with drug-eluting stents. Specific OCT-identified lesion characteristics were associated with suboptimal OCT stent deployment.