title: Clinical Impact of OCT Findings During PCI: The CLI-OPCI II Study.
abstract: OBJECTIVE
  The goal of this study was to assess the clinical impact of optical coherence tomography (OCT) findings during percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  OCT provides unprecedented high-definition visualization of plaque/stent structures during PCI; however, the impact of OCT findings on outcome remains undefined.
  
  
  METHODS
  In the context of the multicenter CLI-OPCI (Centro per la Lotta contro l'Infarto-Optimisation of Percutaneous Coronary Intervention) registry, we retrospectively analyzed patients undergoing end-procedural OCT assessment and compared the findings with clinical outcomes.
  
  
  RESULTS
  A total of 1,002 lesions (832 patients) were assessed. Appropriate OCT assessment was obtained in 98.2% of cases and revealed suboptimal stent implantation in 31.0% of lesions, with increased incidence in patients experiencing major adverse cardiac events (MACE) during follow-up (59.2% vs. 26.9%; p < 0.001). In particular, in-stent minimum lumen area <4.5 mm(2) (hazards ratio [HR]: 1.64; p = 0.040), dissection >200 μm at the distal stent edge (HR: 2.54; p = 0.004), and reference lumen area <4.5 mm(2) at either distal (HR: 4.65; p < 0.001) or proximal (HR: 5.73; p < 0.001) stent edges were independent predictors of MACE. Conversely, in-stent minimum lumen area/mean reference lumen area <70% (HR: 1.21; p = 0.45), stent malapposition >200 μm (HR: 1.15; p = 0.52), intrastent plaque/thrombus protrusion >500 μm (HR: 1.00; p = 0.99), and dissection >200 μm at the proximal stent edge (HR: 0.83; p = 0.65) were not associated with worse outcomes. Using multivariable Cox hazard analysis, the presence of at least 1 significant criterion for suboptimal OCT stent deployment was confirmed as an independent predictor of MACE (HR: 3.53; 95% confidence interval: 2.2 to 5.8; p < 0.001).
  
  
  CONCLUSIONS
  Suboptimal stent deployment defined according to specific quantitative OCT criteria was associated with an increased risk of MACE during follow-up.
authors.affiliation: San Giovanni Addolorata Hospital, Rome, Italy; Centro per la Lotta contro l'Infarto-CLI Foundation, Rome, Italy. Electronic address: fprati@hsangiovanni.roma.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Prati
authors.affiliation: Centro per la Lotta contro l'Infarto-CLI Foundation, Rome, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Romagnoli
authors.affiliation: Università Cattolica Del Sacro Cuore, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Burzotta
authors.affiliation: Misericordia Hospital, Grosseto, Italy.
authors.forename: Ugo
authors.initials: U
authors.lastname: Limbruno
authors.affiliation: San Giovanni Addolorata Hospital, Rome, Italy; Centro per la Lotta contro l'Infarto-CLI Foundation, Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Gatto
authors.affiliation: Division of Cardiology, University of Catania, Catania, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: La Manna
authors.affiliation: Ospedale Civile Ferdinando Veneziale, Isernia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Versaci
authors.affiliation: Centro per la Lotta contro l'Infarto-CLI Foundation, Rome, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Marco
authors.affiliation: San Giovanni Addolorata Hospital, Rome, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Di Vito
authors.affiliation: San Giovanni Addolorata Hospital, Rome, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Imola
authors.affiliation: Centro per la Lotta contro l'Infarto-CLI Foundation, Rome, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Paoletti
authors.affiliation: Università Cattolica Del Sacro Cuore, Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Trani
authors.affiliation: Division of Cardiology, University of Catania, Catania, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.affiliation: GVM Care and Research, E.S. Health Science Foundation, Cotignola, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
authors.affiliation: Cardiovascular Research Foundation, New York, New York.
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D023903:Coronary Restenosis / Q000209:etiology / Q000473:pathology; D003328:Coronary Thrombosis / Q000209:etiology / Q000473:pathology; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology / Q000473:pathology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome
keywords: clinical outcome; optical coherence tomography; percutaneous coronary intervention; registry