Long-term consequences of optical coherence tomography findings during percutaneous coronary intervention: The Centro per la Lotta Contro L'infarto - Optimization of Percutaneous Coronary Intervention (CLI-OPCI) LATE study

Abstract

Aims: The role of intraprocedural optical coherence tomography (OCT) on the long-term clinical outcome of percutaneous coronary interventions (PCI) remains undefined. The aim of the present study was to evaluate the impact of quantitative OCT-defined suboptimal stent implantation at long-term follow-up. Methods and results: In the context of the multicentre Centro per la Lotta contro l'Infarto - Optimisation of Percutaneous Coronary Intervention (CLI-OPCI) registry, we compared the long-term PCI outcome of 1,211 patients from 13 independent OCT-experienced centres according to end-procedural OCT findings. OCT assessment revealed suboptimal stent implantation in 30.9% of lesions, with an increased prevalence in patients experiencing device-oriented cardiovascular events (DoCE) (52.8% vs. 28.0%, p<0.001). At a median follow-up of 833 (interquartile range 415-1,447) days, in-stent minimum lumen area (MLA) <4.5 mm2 (HR 1.82, p<0.001), distal stent edge dissection >200 μm (HR 2.03, p=0.004), and significant reference vessel plaque and lumen area <4.5 mm2 at either the distal (HR 5.22, p<0.001) or proximal (HR 5.67, p<0.001) stent edges were independent predictors of device failure. Conversely, in-stent MLA/mean reference lumen area <70%, acute stent malapposition, and intra-stent plaque/thrombus protrusion were not associated with worse outcomes. Using multivariable Cox hazard analysis, the presence of at least one of the significant criteria for suboptimal OCT stent deployment was confirmed as an independent predictor of DoCE (HR 1.92, p=0.001). Conclusions: Suboptimal stent deployment, defined according to specific quantitative OCT criteria, was confirmed as an independent outcome predictor at long-term follow-up.