TY - JOUR
T1 - Optical coherence tomography predictors of clinical outcomes after stent implantation
T2 - the ILUMIEN IV trial
AU - Landmesser, Ulf
AU - Ali, Ziad A.
AU - Maehara, Akiko
AU - Matsumura, Mitsuaki
AU - Shlofmitz, Richard A.
AU - Guagliumi, Giulio
AU - Price, Matthew J.
AU - Hill, Jonathan M.
AU - Akasaka, Takashi
AU - Prati, Francesco
AU - Bezerra, Hiram G.
AU - Wijns, William
AU - Leistner, David
AU - Canova, Paolo
AU - Alfonso, Fernando
AU - Fabbiocchi, Franco
AU - Calligaris, Giuseppe
AU - Oemrawsingh, Rohit M.
AU - Achenbach, Stephan
AU - Trani, Carlo
AU - Singh, Balbir
AU - McGreevy, Robert J.
AU - McNutt, Robert W.
AU - Ying, Shih Wa
AU - Buccola, Jana
AU - Stone, Gregg W.
N1 - Publisher Copyright:
© The Author(s) 2024.
PY - 2024/11/14
Y1 - 2024/11/14
N2 - 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.
AB - 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.
KW - Optical coherence tomography
KW - Percutaneous coronary intervention
KW - Prognosis
KW - Stent
UR - http://www.scopus.com/inward/record.url?scp=85209261042&partnerID=8YFLogxK
U2 - 10.1093/eurheartj/ehae521
DO - 10.1093/eurheartj/ehae521
M3 - Article
C2 - 39196989
AN - SCOPUS:85209261042
SN - 0195-668X
VL - 45
SP - 4630
EP - 4643
JO - European Heart Journal
JF - European Heart Journal
IS - 43
ER -