Clinical Implications of Poststent Optical Coherence Tomographic Findings: Severe Malapposition and Cardiac Events

Abstract

Objectives: This study sought to evaluate the impact of poststent optical coherence tomography (OCT) findings, including severe malapposition, on long-term clinical outcomes.

Background: Suboptimal OCT findings following percutaneous coronary intervention (PCI) are highly prevalent; however, their clinical implications remain controversial.

Methods: Of the patients registered in the Yonsei OCT registry, a total of 1,290 patients with 1,348 lesions, who underwent OCT immediately poststenting, were consecutively enrolled for this study. All patients underwent implantation of drug-eluting stents. Poststent OCT findings were assessed to identify predictors of device-oriented clinical endpoints (DoCE), including cardiac death, target vessel-related myocardial infarction (MI) or stent thrombosis, and target lesion revascularization (TLR). Significant malapposition criteria associated with major safety events (MSE) were also investigated, such as cardiac death, target vessel-related MI, or stent thrombosis.

Results: The median follow-up period was 43.0 months (interquartile range [IQR] 21.4 to 56.0 months). The incidence rates of stent edge dissection, tissue prolapse, thrombus, and malapposition after intervention were not associated with occurrence of DoCE. However, patients with significant malapposition (total malapposition volume [TMV] ≥7.0 mm3] exhibited more frequent MSE. A smaller minimal stent area (MSA) was identified as an independent predictor for DoCE (hazard ratio [HR]: 1.20 [95% confidence interval [CI]: 1.00 to 1.43]; p = 0.045). Malapposition with TMV ≥7.0 mm3 was found to be an independent predictor of MSE (HR: 6.12 [95% CI: 1.88 to 19.95]; p = 0.003). Follow-up OCT at 3, 6, or 9 months after PCI showed that poststent TMV ≥7.0 mm3 was related to a greater occurrence of late malapposition and uncovered struts.

Conclusions: Although most suboptimal OCT findings were not associated with clinical outcomes, a smaller MSA was associated with DoCE, driven mainly by TLR, and significant malapposition with TMV ≥7.0 mm3 was associated with more MSE after PCI. (Yonsei OCT [Optical Coherence Tomography] Registry for Evaluation of Efficacy and Safety of Coronary Stenting; Yonsei OCT registry; NCT02099162).

Keywords: drug-eluting stent(s); malapposition; optical coherence tomography; percutaneous coronary intervention; total malapposition volume.

Conflict of interest statement

Funding Support and Author Disclosures This research was supported by the Technology Innovation Program (20012442, MultiPhase Implant with Biodegradable and Magnetic Features for Biological Flow Organs), funded by the Ministry of Trade, Industry and Energy (MOTIE, Korea), by a National Research Foundation of Korea grant funded by the Korean government (MSIT) (2017R1A2B2003191) and the Cardiovascular Research Center (Seoul, Korea). Dr. Jung-Sun Kim has received proctoring fees from Abbott Vascular and Occlutech. Dr. Guagliumi is a consultant for St. Jude Medical and Boston Scientific; and has received institutional research grants from Abbott Vascular, Boston Scientific, and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.