Clinical implications of post-stent optical coherence tomographic findings after drug-eluting stent implantation: severe malapposition and thrombotic events

Abstract

Background The clinical implications of optical coherence tomography (OCT) assessment following percutaneous coronary intervention are controversial. Purpose We sought to evaluate the impact of post-stent OCT findings, including significant malapposition, on long-term clinical outcomes. Methods A total of 1,290 patients with 1,348 lesions, in which OCT was performed immediately post-stent, were consecutively enrolled in the prospective OCT registry. Post-stent OCT findings were assessed to identify predictors of device-oriented clinical end points (DoCE), including cardiac death, target vessel-related myocardial infarction (MI), stent thrombosis, and target lesion revascularization (TLR). We also looked for significant malapposition criteria that may be associated with thrombotic events such as cardiac death, target vessel-related MI, and stent thrombosis. Results Incidences of stent edge dissection, tissue prolapse, thrombus, and malapposition after intervention were not associated with occurrence of adverse thrombotic events. However, patients with significant malapposition [total malapposition volume (TMV) ≥7.0 mm3 or TMV/stent volume ≥4.1%] exhibited more frequent thrombotic events. In multivariate analysis, smaller minimal stent area (MSA) was identified as an independent predictor for DoCE (hazard ratio [HR], 1.21 [1.01–1.45]; P=0.037). Malapposition with TMV ≥7.0 mm3 was found to be an independent predictor of thrombotic events (HR, 4.62 [1.29–16.47]; P=0.018). Conclusions Although most high-resolution OCT findings were not associated with clinical outcome, smaller MSA was associated with DoCE, driven mainly by TLR, and significant malapposition with TMV ≥7.0 mm3 was associated with more thrombotic events after drug-eluting stent implantation. Kaplan-Meier curve Funding Acknowledgement Type of funding source: None

Determinants and long‐term outcomes of largely uncovered struts in thin‐struts drug‐eluting stents assessed by optical coherence tomography

“…Malapposed struts are more frequently uncovered at follow‐up, as compared with well‐apposed struts 14 . We found a numerically higher percentage of malapposed struts in the LUS group, immediately after stent implantation and at 3‐month follow‐up, with greater but clinically irrelevant malapposition areas and volumes 15 . However, the optimal stent deployment with an expansion index of 84% in both groups, achieved with contemporary implantation techniques assisted by OCT, has considerably reduced the number of US related to malapposition, to the point that only 14% of US in the LUS group were malapposed at 3 months, with a minimal malapposition area.…”

“…14 We found a numerically higher percentage of malapposed struts in the LUS group, immediately after stent implantation and at 3-month follow-up, with greater but clinically irrelevant malapposition areas and volumes. 15 However, the optimal stent deployment with an expansion index of 84% in both groups, achieved with…”