From Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA (T.S., R.V., Y.M., D.S.O., L.G., I.-K.J.); First Department of Medicine, Nara Medical University, Kashihara, Japan (T.S., S.U., Y.S.); Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.-J.P.,); Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (Y.J.); Queen Mary Hospital, Hong Kong University, Hong Kong (S.L.); Division of Cardiology, Kyung Hee University, Seoul, Republic of Korea (J.-M.C., S.-J.K., I.-K.J.); Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA (H.L.,); and Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China (S.Z., B.Y.).
Circulation. 2015 Sep 15;132(11):1020-9. doi: 10.1161/CIRCULATIONAHA.114.014704. Epub 2015 Jul 10.
Optical coherence tomography (OCT) was recently introduced to optimize percutaneous coronary intervention. However, the exact incidence and significance of poststent OCT findings are unknown.
A total of 900 lesions treated with 1001 stents in 786 patients who had postprocedure OCT imaging were analyzed to evaluate the incidence of poststent OCT findings and to identify the OCT predictors for device-oriented clinical end points, including cardiac death, target vessel-related myocardial infarction, target lesion revascularization, and stent thrombosis. Patients were followed up to 1 year. Stent edge dissection was detected in 28.7% of lesions, and incomplete stent apposition was detected in 39.1% of lesions. The incidences of smooth protrusion, disrupted fibrous tissue protrusion, and irregular protrusion were 92.9%, 61.0%, and 53.8%, respectively. Small minimal stent area, defined as a lesion with minimal stent area <5.0 mm(2) in a drug-eluting stent or <5.6 mm(2) in a bare metal stent, was observed in 40.4% of lesions. One-year device-oriented clinical end points occurred in 33 patients (4.5%). Following adjustment, irregular protrusion and small minimal stent area were independent OCT predictors of 1-year device-oriented clinical end points (P=0.003 and P=0.012, respectively).
Abnormal poststent OCT findings were frequent. Irregular protrusion and small minimal stent area were independent predictors of 1-year device-oriented clinical end points, which were primarily driven by target lesion revascularization.
光学相干断层扫描（OCT）最近被引入以优化经皮冠状动脉介入治疗。然而，支架内 OCT 结果的确切发生率和意义尚不清楚。
对 786 例患者的 900 个病变（共植入 1001 个支架）进行了术后 OCT 成像分析，以评估支架内 OCT 结果的发生率，并确定与器械相关的临床终点（包括心脏性死亡、靶血管相关心肌梗死、靶病变血运重建和支架血栓形成）的 OCT 预测因子。患者接受了 1 年的随访。28.7%的病变检测到支架边缘夹层，39.1%的病变检测到支架贴壁不良。光滑突起、纤维组织破坏突起和不规则突起的发生率分别为 92.9%、61.0%和 53.8%。小最小支架面积（定义为药物洗脱支架中最小支架面积<5.0mm2或裸金属支架中最小支架面积<5.6mm2的病变）在 40.4%的病变中观察到。33 例患者（4.5%）在 1 年内发生了器械相关的临床终点事件。调整后，不规则突起和小最小支架面积是 1 年器械相关临床终点的独立 OCT 预测因子（P=0.003 和 P=0.012）。
支架内 OCT 异常结果很常见。不规则突起和小最小支架面积是 1 年器械相关临床终点的独立预测因子，主要由靶病变血运重建驱动。
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