title: Optical Coherence Tomography Guided Percutaneous Coronary Intervention With Nobori Stent Implantation in Patients With Non-ST-Segment-Elevation Myocardial Infarction (OCTACS) Trial: Difference in Strut Coverage and Dynamic Malapposition Patterns at 6 Months.
abstract: BACKGROUND
  Incomplete strut coverage has been documented an important histopathologic morphometric predictor for later thrombotic events. This study sought to investigate whether optical coherence tomography (OCT)-guided percutaneous coronary intervention with Nobori biolimus-eluting stent implantation in patients with non-ST-segment-elevation myocardial infarction would provide improved strut coverage at 6 months in comparison with angiographic guidance only.
  
  
  RESULTS
  One hundred patients were randomized 1:1 to either OCT-guided or angio-guided Nobori biolimus-eluting stent implantation. Postprocedure OCT was performed in all patients. In the OCT-guided group, prespecified criteria indicating additional intervention were related to (1) stent underexpansion, (2) strut malapposition, (3) edge dissection(s), and (4) residual stenosis at the distal or proximal reference segment(s). A final OCT was performed in case of reintervention. Six-month OCT follow-up was available in 85 patients. Twenty-three (46%) OCT-guided patients had additional postdilation or stenting. The percentage of acutely malapposed struts was substantially lower in the OCT-guided group (3.4% [interquartile range, 0.3-7.6] versus 7.8% [interquartile range, 2.3-19.4]; P<0.01). At 6-month follow-up, the OCT-guided group had a significantly lower proportion of uncovered struts; 4.3% [interquartile range, 1.2-9.8] versus 9.0% [interquartile range, 5.5-14.5], P<0.01. Furthermore, OCT-guided patients had significantly more completely covered stents: 17.5% versus 2.2%, P=0.02. The percentages of malapposed struts and struts being both uncovered and malapposed at follow-up were comparable between groups.
  
  
  CONCLUSIONS
  OCT-guided optimization of Nobori biolimus-eluting stent implantation improves strut coverage at 6-month follow-up in comparison with angiographic guidance alone.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT02272283.
authors.affiliation: From the Department of Cardiology, Odense University Hospital, Odense, Denmark (L.A., P.T., H.S.H., A.J., K.T.V., K.N.H., M.H., L.O.J.); and Departments of Cardiology, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.). Lisbeth.antonsen@rsyd.dk.
authors.forename: Lisbeth
authors.initials: L
authors.lastname: Antonsen
authors.affiliation: From the Department of Cardiology, Odense University Hospital, Odense, Denmark (L.A., P.T., H.S.H., A.J., K.T.V., K.N.H., M.H., L.O.J.); and Departments of Cardiology, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.).
authors.forename: Per
authors.initials: P
authors.lastname: Thayssen
authors.affiliation: From the Department of Cardiology, Odense University Hospital, Odense, Denmark (L.A., P.T., H.S.H., A.J., K.T.V., K.N.H., M.H., L.O.J.); and Departments of Cardiology, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.).
authors.forename: Akiko
authors.initials: A
authors.lastname: Maehara
authors.affiliation: From the Department of Cardiology, Odense University Hospital, Odense, Denmark (L.A., P.T., H.S.H., A.J., K.T.V., K.N.H., M.H., L.O.J.); and Departments of Cardiology, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.).
authors.forename: Henrik Steen
authors.initials: HS
authors.lastname: Hansen
authors.affiliation: From the Department of Cardiology, Odense University Hospital, Odense, Denmark (L.A., P.T., H.S.H., A.J., K.T.V., K.N.H., M.H., L.O.J.); and Departments of Cardiology, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.).
authors.forename: Anders
authors.initials: A
authors.lastname: Junker
authors.affiliation: From the Department of Cardiology, Odense University Hospital, Odense, Denmark (L.A., P.T., H.S.H., A.J., K.T.V., K.N.H., M.H., L.O.J.); and Departments of Cardiology, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.).
authors.forename: Karsten Tange
authors.initials: KT
authors.lastname: Veien
authors.affiliation: From the Department of Cardiology, Odense University Hospital, Odense, Denmark (L.A., P.T., H.S.H., A.J., K.T.V., K.N.H., M.H., L.O.J.); and Departments of Cardiology, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.).
authors.forename: Knud Nørregaard
authors.initials: KN
authors.lastname: Hansen
authors.affiliation: From the Department of Cardiology, Odense University Hospital, Odense, Denmark (L.A., P.T., H.S.H., A.J., K.T.V., K.N.H., M.H., L.O.J.); and Departments of Cardiology, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.).
authors.forename: Mikkel
authors.initials: M
authors.lastname: Hougaard
authors.affiliation: From the Department of Cardiology, Odense University Hospital, Odense, Denmark (L.A., P.T., H.S.H., A.J., K.T.V., K.N.H., M.H., L.O.J.); and Departments of Cardiology, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.).
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.affiliation: From the Department of Cardiology, Odense University Hospital, Odense, Denmark (L.A., P.T., H.S.H., A.J., K.T.V., K.N.H., M.H., L.O.J.); and Departments of Cardiology, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.).
authors.forename: Lisette Okkels
authors.initials: LO
authors.lastname: Jensen
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D054855:Drug-Eluting Stents; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011446:Prospective Studies; D011897:Random Allocation; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000627:therapeutic use; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; C518022:umirolimus; D020123:Sirolimus
keywords: drug-eluting stents; myocardial infarction; optical coherence tomography; percutaneous coronary intervention; stents