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Clinical Implications of Poststent Optical Coherence Tomographic Findings: Severe Malapposition and Cardiac Events
- Title
- Clinical Implications of Poststent Optical Coherence Tomographic Findings: Severe Malapposition and Cardiac Events
- Authors
- Kim B.G.; Kachel M.; Kim J.-S.; Guagliumi G.; Kim C.; Kim I.-S.; Lee Y.-J.; Lee O.-H.; Byun Y.S.; Kim B.O.; Milewski K.; Lee S.-J.; Hong S.-J.; Ahn C.-M.; Shin D.-H.; Kim B.-K.; Ko Y.-G.; Choi D.; Jang Y.
- Ewha Authors
- 김충기
- SCOPUS Author ID
- 김충기
- Issue Date
- 2022
- Journal Title
- JACC: Cardiovascular Imaging
- ISSN
- 1936-878X
- Citation
- JACC: Cardiovascular Imaging vol. 15, no. 1, pp. 126 - 137
- Keywords
- drug-eluting stent(s); malapposition; optical coherence tomography; percutaneous coronary intervention; total malapposition volume
- Publisher
- Elsevier Inc.
- Indexed
- SCIE; SCOPUS
- Document Type
- Article
- Abstract
- Objectives: This study sought to evaluate the impact of poststent optical coherence tomography (OCT) findings, including severe malapposition, on long-term clinical outcomes. Background: Suboptimal OCT findings following percutaneous coronary intervention (PCI) are highly prevalent; however, their clinical implications remain controversial. Methods: Of the patients registered in the Yonsei OCT registry, a total of 1,290 patients with 1,348 lesions, who underwent OCT immediately poststenting, were consecutively enrolled for this study. All patients underwent implantation of drug-eluting stents. Poststent OCT findings were assessed to identify predictors of device-oriented clinical endpoints (DoCE), including cardiac death, target vessel-related myocardial infarction (MI) or stent thrombosis, and target lesion revascularization (TLR). Significant malapposition criteria associated with major safety events (MSE) were also investigated, such as cardiac death, target vessel-related MI, or stent thrombosis. Results: The median follow-up period was 43.0 months (interquartile range [IQR] 21.4 to 56.0 months). The incidence rates of stent edge dissection, tissue prolapse, thrombus, and malapposition after intervention were not associated with occurrence of DoCE. However, patients with significant malapposition (total malapposition volume [TMV] ≥7.0 mm3] exhibited more frequent MSE. A smaller minimal stent area (MSA) was identified as an independent predictor for DoCE (hazard ratio [HR]: 1.20 [95% confidence interval [CI]: 1.00 to 1.43]; p = 0.045). Malapposition with TMV ≥7.0 mm3 was found to be an independent predictor of MSE (HR: 6.12 [95% CI: 1.88 to 19.95]; p = 0.003). Follow-up OCT at 3, 6, or 9 months after PCI showed that poststent TMV ≥7.0 mm3 was related to a greater occurrence of late malapposition and uncovered struts. Conclusions: Although most suboptimal OCT findings were not associated with clinical outcomes, a smaller MSA was associated with DoCE, driven mainly by TLR, and significant malapposition with TMV ≥7.0 mm3 was associated with more MSE after PCI. (Yonsei OCT [Optical Coherence Tomography] Registry for Evaluation of Efficacy and Safety of Coronary Stenting; Yonsei OCT registry; NCT02099162) © 2022 American College of Cardiology Foundation
- DOI
- 10.1016/j.jcmg.2021.03.008
- Appears in Collections:
- 의료원 > 의료원 > Journal papers
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