Clinical Impact of OCT Findings During PCI The CLI-OPCI II Study

OBJECTIVES The goal of this study was to assess the clinical impact of optical coherence tomography (OCT) findings during percutaneous coronary intervention (PCI). BACKGROUND OCT provides unprecedented high-definition visualization of plaque/stent structures during PCI; however, the impact of OCT findings on outcome remains undefined. METHODS In the context of the multicenter CLI-OPCI (Centro per La Lotta contro l'Infarto-Optimisation of Percutaneous Coronary Intervention) registry, we retrospectively analyzed patients undergoing end-procedural OCT assessment and compared the findings with clinical outcomes. RESULTS A total of 1,002 lesions (832 patients) were assessed. Appropriate OCT assessment was obtained in 98.2% of cases and revealed suboptimal stent implantation in 31.0% of lesions, with increased incidence in patients experiencing major adverse cardiac events (MACE) during follow-up (59.2% vs. 26.9%; p < 0.001). In particular, in-stent minimum Lumen area <4.5 mm(2) (hazards ratio [HR]: 1.64; p = 0.040), dissection >200 mu m at the distal stent edge (FIR: 2.54; p = 0.004), and reference lumen area <4.5 mm(2) at either distal (HR: 4.65; p < 0.001) or proximal (HR: 5.73; p < 0.001) stent edges were independent predictors of MACE. Conversely, in-stent minimum Lumen area/mean reference lumen area <70% (FIR: 1.21; p = 0.45), stent malapposition >200 mu m (HR: 1.15; p = 0.52), intrastent plaque/thrombus protrusion >500 mu m (HR: 1.00; p = 0.99), and dissection >200 mu m at the proximal stent edge (HR: 0.83; p = 0.65) were not associated with worse outcomes. Using multivariable Cox hazard analysis, the presence of at least 1 significant criterion for suboptimal OCT stent deployment was confirmed as an independent predictor of MACE (HR: 3.53; 95% confidence interval: 2.2 to 5.8; p < 0.001). CONCLUSIONS Suboptimal stent deployment defined according to specific quantitative OCT criteria was associated with an increased risk of MACE during follow-up.(C) 2015 by the American College of Cardiology Foundation.