Optical coherence tomography predictors of clinical outcomes after stent implantation: the ILUMIEN IV trial

Ulf Landmesser, Ziad A. Ali, Akiko Maehara, Mitsuaki Matsumura, Richard A. Shlofmitz, Giulio Guagliumi, Matthew J. Price, Jonathan M. Hill, Takashi Akasaka, Francesco Prati, Hiram G. Bezerra, William Wijns, David Leistner, Paolo Canova, Fernando Alfonso, Franco Fabbiocchi, Giuseppe Calligaris, Rohit M. Oemrawsingh, Stephan Achenbach, Carlo TraniBalbir Singh, Robert J. McGreevy, Robert W. McNutt, Shih Wa Ying, Jana Buccola, Gregg W. Stone

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Background and Observational registries have suggested that optical coherence tomography (OCT) imaging-derived parameters may predict Aims adverse events after drug-eluting stent (DES) implantation. The present analysis sought to determine the OCT predictors of clinical outcomes from the large-scale ILUMIEN IV trial. Methods ILUMIEN IV was a prospective, single-blind trial of 2487 patients with diabetes or high-risk lesions randomized to OCT-guided versus angiography-guided DES implantation. All patients underwent final OCT imaging (blinded in the angiography-guided arm). From more than 20 candidates, the independent OCT predictors of 2-year target lesion failure (TLF; the primary endpoint), cardiac death or target-vessel myocardial infarction (TV-MI), ischaemia-driven target lesion revascularization (ID-TLR), and stent thrombosis were analysed by multivariable Cox proportional hazard regression in single treated lesions. Results A total of 2128 patients had a single treated lesion with core laboratory-analysed final OCT. The 2-year Kaplan–Meier rates of TLF, cardiac death or TV-MI, ID-TLR, and stent thrombosis were 6.3% (n = 130), 3.3% (n = 68), 4.3% (n = 87), and 0.9% (n = 18), respectively. The independent predictors of 2-year TLF were a smaller minimal stent area (per 1 mm2 increase: hazard ratio 0.76, 95% confidence interval 0.68–0.89, P < .0001) and proximal edge dissection (hazard ratio 1.77, 95% confidence interval 1.20–2.62, P = .004). The independent predictors of cardiac death or TV-MI were smaller minimal stent area and longer stent length; of ID-TLR were smaller intra-stent flow area and proximal edge dissection; and of stent thrombosis was smaller minimal stent expansion. Conclusions In the ILUMIEN IV trial, the most important OCT-derived post-DES predictors of both safety and effectiveness outcomes were parameters related to stent area, expansion and flow, proximal edge dissection, and stent length.

Original languageEnglish
Pages (from-to)4630-4643
Number of pages14
JournalEuropean Heart Journal
Volume45
Issue number43
DOIs
StatePublished - 14 Nov 2024

Keywords

  • Optical coherence tomography
  • Percutaneous coronary intervention
  • Prognosis
  • Stent

Fingerprint

Dive into the research topics of 'Optical coherence tomography predictors of clinical outcomes after stent implantation: the ILUMIEN IV trial'. Together they form a unique fingerprint.

Cite this