title: Clinical Impact of Suboptimal Stenting and Residual Intrastent Plaque/Thrombus Protrusion in Patients With Acute Coronary Syndrome: The CLI-OPCI ACS Substudy (Centro per la Lotta Contro L'Infarto-Optimization of Percutaneous Coronary Intervention in Acute Coronary Syndrome).
abstract: Clinical consequences of optical coherence tomographic (OCT) high-definition visualization of plaque/stent structures in acute patients remain undefined. In this retrospective substudy, we assessed the prognostic impact of postprocedural culprit lesion OCT findings in patients with acute coronary syndrome undergoing percutaneous coronary intervention.
  
  
  
  In the CLI-OPCI (Centro per la Lotta Contro L'Infarto-Optimization of Percutaneous Coronary Intervention) database collecting cases from 5 independent OCT-experienced centers, we retrospectively analyzed postprocedural OCT findings in acute coronary syndrome patients and explored its possible impact (specifically that of residual intrastent plaque/thrombus protrusion) on outcome. From 2009 to 2013, 507 patients (588 lesions) were evaluated. Patients experiencing device-oriented cardiovascular events showed more frequently the features of suboptimal stent implantation defined as the presence of significant residual intrastent plaque/thrombus protrusion (hazard ratio [HR], 2.35; P<0.01), in-stent minimum lumen area (MLA) <4.5 mm2(HR, 2.72; P<0.01), dissection >200 µm at distal stent edge (HR, 3.84; P<0.01), and reference lumen area <4.5 mm2at either distal (HR, 6.07; P<0.001) or proximal (HR, 8.50; P<0.001) stent edges. Postprocedural OCT assessment of treated culprit lesion revealed at least one of these parameters in 55.2% of cases, with an associated increased risk of device-oriented cardiovascular events during follow-up (17.9% versus 4.8%; P<0.001). Both the presence of at least one of these parameters (HR, 3.69; P=0.002) and the residual intrastent plaque/thrombus protrusion (HR, 2.83; P=0.008) were confirmed as independent predictors of device-oriented cardiovascular events.
  
  
  
  In this retrospective study of acute coronary syndrome patients undergoing percutaneous coronary intervention, a composite of OCT-defined suboptimal stent implantation characteristics at the culprit lesion and residual intrastent plaque/thrombus protrusion was associated with adverse outcome.
authors.affiliation: From the Division of Cardiology, San Giovanni Addolorata Hospital, Rome, Italy (F.P., L.G., V.R., L.D.V.); Centro per la Lotta Contro L'Infarto-CLI Foundation, Rome, Italy (F.P., E.R., L.G., A.D.G., V.M.); Division of Cardiology, University of Catania, Italy (A.L.M.); Cardiovascular Department, Università Cattolica Del Sacro Cuore, Rome, Italy (F.B., C.T., I.P.); Division of Cardiology, Misericordia Hospital, Grosseto, Italy (U.L.); Division of Cardiology, Ospedale Civile Ferdinando Veneziale, Isernia, Italy (F.V.); Centro Cardiologico Monzino IRCCS, Milano, Italy (F.F.); Division of Cardiology, Ospedale Brotzu, Cagliari, Italy (A.B.); GVM Care and Research, E.S. Health Science Foundation, Cotignola, Italy (L.T.); and Cardiovascular Research Foundation, New York, NY (G.S.M.). fprati@hsangiovanni.roma.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Prati
authors.affiliation: From the Division of Cardiology, San Giovanni Addolorata Hospital, Rome, Italy (F.P., L.G., V.R., L.D.V.); Centro per la Lotta Contro L'Infarto-CLI Foundation, Rome, Italy (F.P., E.R., L.G., A.D.G., V.M.); Division of Cardiology, University of Catania, Italy (A.L.M.); Cardiovascular Department, Università Cattolica Del Sacro Cuore, Rome, Italy (F.B., C.T., I.P.); Division of Cardiology, Misericordia Hospital, Grosseto, Italy (U.L.); Division of Cardiology, Ospedale Civile Ferdinando Veneziale, Isernia, Italy (F.V.); Centro Cardiologico Monzino IRCCS, Milano, Italy (F.F.); Division of Cardiology, Ospedale Brotzu, Cagliari, Italy (A.B.); GVM Care and Research, E.S. Health Science Foundation, Cotignola, Italy (L.T.); and Cardiovascular Research Foundation, New York, NY (G.S.M.).
authors.forename: Enrico
authors.initials: E
authors.lastname: Romagnoli
authors.affiliation: From the Division of Cardiology, San Giovanni Addolorata Hospital, Rome, Italy (F.P., L.G., V.R., L.D.V.); Centro per la Lotta Contro L'Infarto-CLI Foundation, Rome, Italy (F.P., E.R., L.G., A.D.G., V.M.); Division of Cardiology, University of Catania, Italy (A.L.M.); Cardiovascular Department, Università Cattolica Del Sacro Cuore, Rome, Italy (F.B., C.T., I.P.); Division of Cardiology, Misericordia Hospital, Grosseto, Italy (U.L.); Division of Cardiology, Ospedale Civile Ferdinando Veneziale, Isernia, Italy (F.V.); Centro Cardiologico Monzino IRCCS, Milano, Italy (F.F.); Division of Cardiology, Ospedale Brotzu, Cagliari, Italy (A.B.); GVM Care and Research, E.S. Health Science Foundation, Cotignola, Italy (L.T.); and Cardiovascular Research Foundation, New York, NY (G.S.M.).
authors.forename: Laura
authors.initials: L
authors.lastname: Gatto
authors.affiliation: From the Division of Cardiology, San Giovanni Addolorata Hospital, Rome, Italy (F.P., L.G., V.R., L.D.V.); Centro per la Lotta Contro L'Infarto-CLI Foundation, Rome, Italy (F.P., E.R., L.G., A.D.G., V.M.); Division of Cardiology, University of Catania, Italy (A.L.M.); Cardiovascular Department, Università Cattolica Del Sacro Cuore, Rome, Italy (F.B., C.T., I.P.); Division of Cardiology, Misericordia Hospital, Grosseto, Italy (U.L.); Division of Cardiology, Ospedale Civile Ferdinando Veneziale, Isernia, Italy (F.V.); Centro Cardiologico Monzino IRCCS, Milano, Italy (F.F.); Division of Cardiology, Ospedale Brotzu, Cagliari, Italy (A.B.); GVM Care and Research, E.S. Health Science Foundation, Cotignola, Italy (L.T.); and Cardiovascular Research Foundation, New York, NY (G.S.M.).
authors.forename: Alessio
authors.initials: A
authors.lastname: La Manna
authors.affiliation: From the Division of Cardiology, San Giovanni Addolorata Hospital, Rome, Italy (F.P., L.G., V.R., L.D.V.); Centro per la Lotta Contro L'Infarto-CLI Foundation, Rome, Italy (F.P., E.R., L.G., A.D.G., V.M.); Division of Cardiology, University of Catania, Italy (A.L.M.); Cardiovascular Department, Università Cattolica Del Sacro Cuore, Rome, Italy (F.B., C.T., I.P.); Division of Cardiology, Misericordia Hospital, Grosseto, Italy (U.L.); Division of Cardiology, Ospedale Civile Ferdinando Veneziale, Isernia, Italy (F.V.); Centro Cardiologico Monzino IRCCS, Milano, Italy (F.F.); Division of Cardiology, Ospedale Brotzu, Cagliari, Italy (A.B.); GVM Care and Research, E.S. Health Science Foundation, Cotignola, Italy (L.T.); and Cardiovascular Research Foundation, New York, NY (G.S.M.).
authors.forename: Francesco
authors.initials: F
authors.lastname: Burzotta
authors.affiliation: From the Division of Cardiology, San Giovanni Addolorata Hospital, Rome, Italy (F.P., L.G., V.R., L.D.V.); Centro per la Lotta Contro L'Infarto-CLI Foundation, Rome, Italy (F.P., E.R., L.G., A.D.G., V.M.); Division of Cardiology, University of Catania, Italy (A.L.M.); Cardiovascular Department, Università Cattolica Del Sacro Cuore, Rome, Italy (F.B., C.T., I.P.); Division of Cardiology, Misericordia Hospital, Grosseto, Italy (U.L.); Division of Cardiology, Ospedale Civile Ferdinando Veneziale, Isernia, Italy (F.V.); Centro Cardiologico Monzino IRCCS, Milano, Italy (F.F.); Division of Cardiology, Ospedale Brotzu, Cagliari, Italy (A.B.); GVM Care and Research, E.S. Health Science Foundation, Cotignola, Italy (L.T.); and Cardiovascular Research Foundation, New York, NY (G.S.M.).
authors.forename: Ugo
authors.initials: U
authors.lastname: Limbruno
authors.affiliation: From the Division of Cardiology, San Giovanni Addolorata Hospital, Rome, Italy (F.P., L.G., V.R., L.D.V.); Centro per la Lotta Contro L'Infarto-CLI Foundation, Rome, Italy (F.P., E.R., L.G., A.D.G., V.M.); Division of Cardiology, University of Catania, Italy (A.L.M.); Cardiovascular Department, Università Cattolica Del Sacro Cuore, Rome, Italy (F.B., C.T., I.P.); Division of Cardiology, Misericordia Hospital, Grosseto, Italy (U.L.); Division of Cardiology, Ospedale Civile Ferdinando Veneziale, Isernia, Italy (F.V.); Centro Cardiologico Monzino IRCCS, Milano, Italy (F.F.); Division of Cardiology, Ospedale Brotzu, Cagliari, Italy (A.B.); GVM Care and Research, E.S. Health Science Foundation, Cotignola, Italy (L.T.); and Cardiovascular Research Foundation, New York, NY (G.S.M.).
authors.forename: Francesco
authors.initials: F
authors.lastname: Versaci
authors.affiliation: From the Division of Cardiology, San Giovanni Addolorata Hospital, Rome, Italy (F.P., L.G., V.R., L.D.V.); Centro per la Lotta Contro L'Infarto-CLI Foundation, Rome, Italy (F.P., E.R., L.G., A.D.G., V.M.); Division of Cardiology, University of Catania, Italy (A.L.M.); Cardiovascular Department, Università Cattolica Del Sacro Cuore, Rome, Italy (F.B., C.T., I.P.); Division of Cardiology, Misericordia Hospital, Grosseto, Italy (U.L.); Division of Cardiology, Ospedale Civile Ferdinando Veneziale, Isernia, Italy (F.V.); Centro Cardiologico Monzino IRCCS, Milano, Italy (F.F.); Division of Cardiology, Ospedale Brotzu, Cagliari, Italy (A.B.); GVM Care and Research, E.S. Health Science Foundation, Cotignola, Italy (L.T.); and Cardiovascular Research Foundation, New York, NY (G.S.M.).
authors.forename: Franco
authors.initials: F
authors.lastname: Fabbiocchi
authors.affiliation: From the Division of Cardiology, San Giovanni Addolorata Hospital, Rome, Italy (F.P., L.G., V.R., L.D.V.); Centro per la Lotta Contro L'Infarto-CLI Foundation, Rome, Italy (F.P., E.R., L.G., A.D.G., V.M.); Division of Cardiology, University of Catania, Italy (A.L.M.); Cardiovascular Department, Università Cattolica Del Sacro Cuore, Rome, Italy (F.B., C.T., I.P.); Division of Cardiology, Misericordia Hospital, Grosseto, Italy (U.L.); Division of Cardiology, Ospedale Civile Ferdinando Veneziale, Isernia, Italy (F.V.); Centro Cardiologico Monzino IRCCS, Milano, Italy (F.F.); Division of Cardiology, Ospedale Brotzu, Cagliari, Italy (A.B.); GVM Care and Research, E.S. Health Science Foundation, Cotignola, Italy (L.T.); and Cardiovascular Research Foundation, New York, NY (G.S.M.).
authors.forename: Alessandro
authors.initials: A
authors.lastname: Di Giorgio
authors.affiliation: From the Division of Cardiology, San Giovanni Addolorata Hospital, Rome, Italy (F.P., L.G., V.R., L.D.V.); Centro per la Lotta Contro L'Infarto-CLI Foundation, Rome, Italy (F.P., E.R., L.G., A.D.G., V.M.); Division of Cardiology, University of Catania, Italy (A.L.M.); Cardiovascular Department, Università Cattolica Del Sacro Cuore, Rome, Italy (F.B., C.T., I.P.); Division of Cardiology, Misericordia Hospital, Grosseto, Italy (U.L.); Division of Cardiology, Ospedale Civile Ferdinando Veneziale, Isernia, Italy (F.V.); Centro Cardiologico Monzino IRCCS, Milano, Italy (F.F.); Division of Cardiology, Ospedale Brotzu, Cagliari, Italy (A.B.); GVM Care and Research, E.S. Health Science Foundation, Cotignola, Italy (L.T.); and Cardiovascular Research Foundation, New York, NY (G.S.M.).
authors.forename: Valeria
authors.initials: V
authors.lastname: Marco
authors.affiliation: From the Division of Cardiology, San Giovanni Addolorata Hospital, Rome, Italy (F.P., L.G., V.R., L.D.V.); Centro per la Lotta Contro L'Infarto-CLI Foundation, Rome, Italy (F.P., E.R., L.G., A.D.G., V.M.); Division of Cardiology, University of Catania, Italy (A.L.M.); Cardiovascular Department, Università Cattolica Del Sacro Cuore, Rome, Italy (F.B., C.T., I.P.); Division of Cardiology, Misericordia Hospital, Grosseto, Italy (U.L.); Division of Cardiology, Ospedale Civile Ferdinando Veneziale, Isernia, Italy (F.V.); Centro Cardiologico Monzino IRCCS, Milano, Italy (F.F.); Division of Cardiology, Ospedale Brotzu, Cagliari, Italy (A.B.); GVM Care and Research, E.S. Health Science Foundation, Cotignola, Italy (L.T.); and Cardiovascular Research Foundation, New York, NY (G.S.M.).
authors.forename: Vito
authors.initials: V
authors.lastname: Ramazzotti
authors.affiliation: From the Division of Cardiology, San Giovanni Addolorata Hospital, Rome, Italy (F.P., L.G., V.R., L.D.V.); Centro per la Lotta Contro L'Infarto-CLI Foundation, Rome, Italy (F.P., E.R., L.G., A.D.G., V.M.); Division of Cardiology, University of Catania, Italy (A.L.M.); Cardiovascular Department, Università Cattolica Del Sacro Cuore, Rome, Italy (F.B., C.T., I.P.); Division of Cardiology, Misericordia Hospital, Grosseto, Italy (U.L.); Division of Cardiology, Ospedale Civile Ferdinando Veneziale, Isernia, Italy (F.V.); Centro Cardiologico Monzino IRCCS, Milano, Italy (F.F.); Division of Cardiology, Ospedale Brotzu, Cagliari, Italy (A.B.); GVM Care and Research, E.S. Health Science Foundation, Cotignola, Italy (L.T.); and Cardiovascular Research Foundation, New York, NY (G.S.M.).
authors.forename: Luca
authors.initials: L
authors.lastname: Di Vito
authors.affiliation: From the Division of Cardiology, San Giovanni Addolorata Hospital, Rome, Italy (F.P., L.G., V.R., L.D.V.); Centro per la Lotta Contro L'Infarto-CLI Foundation, Rome, Italy (F.P., E.R., L.G., A.D.G., V.M.); Division of Cardiology, University of Catania, Italy (A.L.M.); Cardiovascular Department, Università Cattolica Del Sacro Cuore, Rome, Italy (F.B., C.T., I.P.); Division of Cardiology, Misericordia Hospital, Grosseto, Italy (U.L.); Division of Cardiology, Ospedale Civile Ferdinando Veneziale, Isernia, Italy (F.V.); Centro Cardiologico Monzino IRCCS, Milano, Italy (F.F.); Division of Cardiology, Ospedale Brotzu, Cagliari, Italy (A.B.); GVM Care and Research, E.S. Health Science Foundation, Cotignola, Italy (L.T.); and Cardiovascular Research Foundation, New York, NY (G.S.M.).
authors.forename: Carlo
authors.initials: C
authors.lastname: Trani
authors.affiliation: From the Division of Cardiology, San Giovanni Addolorata Hospital, Rome, Italy (F.P., L.G., V.R., L.D.V.); Centro per la Lotta Contro L'Infarto-CLI Foundation, Rome, Italy (F.P., E.R., L.G., A.D.G., V.M.); Division of Cardiology, University of Catania, Italy (A.L.M.); Cardiovascular Department, Università Cattolica Del Sacro Cuore, Rome, Italy (F.B., C.T., I.P.); Division of Cardiology, Misericordia Hospital, Grosseto, Italy (U.L.); Division of Cardiology, Ospedale Civile Ferdinando Veneziale, Isernia, Italy (F.V.); Centro Cardiologico Monzino IRCCS, Milano, Italy (F.F.); Division of Cardiology, Ospedale Brotzu, Cagliari, Italy (A.B.); GVM Care and Research, E.S. Health Science Foundation, Cotignola, Italy (L.T.); and Cardiovascular Research Foundation, New York, NY (G.S.M.).
authors.forename: Italo
authors.initials: I
authors.lastname: Porto
authors.affiliation: From the Division of Cardiology, San Giovanni Addolorata Hospital, Rome, Italy (F.P., L.G., V.R., L.D.V.); Centro per la Lotta Contro L'Infarto-CLI Foundation, Rome, Italy (F.P., E.R., L.G., A.D.G., V.M.); Division of Cardiology, University of Catania, Italy (A.L.M.); Cardiovascular Department, Università Cattolica Del Sacro Cuore, Rome, Italy (F.B., C.T., I.P.); Division of Cardiology, Misericordia Hospital, Grosseto, Italy (U.L.); Division of Cardiology, Ospedale Civile Ferdinando Veneziale, Isernia, Italy (F.V.); Centro Cardiologico Monzino IRCCS, Milano, Italy (F.F.); Division of Cardiology, Ospedale Brotzu, Cagliari, Italy (A.B.); GVM Care and Research, E.S. Health Science Foundation, Cotignola, Italy (L.T.); and Cardiovascular Research Foundation, New York, NY (G.S.M.).
authors.forename: Alberto
authors.initials: A
authors.lastname: Boi
authors.affiliation: From the Division of Cardiology, San Giovanni Addolorata Hospital, Rome, Italy (F.P., L.G., V.R., L.D.V.); Centro per la Lotta Contro L'Infarto-CLI Foundation, Rome, Italy (F.P., E.R., L.G., A.D.G., V.M.); Division of Cardiology, University of Catania, Italy (A.L.M.); Cardiovascular Department, Università Cattolica Del Sacro Cuore, Rome, Italy (F.B., C.T., I.P.); Division of Cardiology, Misericordia Hospital, Grosseto, Italy (U.L.); Division of Cardiology, Ospedale Civile Ferdinando Veneziale, Isernia, Italy (F.V.); Centro Cardiologico Monzino IRCCS, Milano, Italy (F.F.); Division of Cardiology, Ospedale Brotzu, Cagliari, Italy (A.B.); GVM Care and Research, E.S. Health Science Foundation, Cotignola, Italy (L.T.); and Cardiovascular Research Foundation, New York, NY (G.S.M.).
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
authors.affiliation: From the Division of Cardiology, San Giovanni Addolorata Hospital, Rome, Italy (F.P., L.G., V.R., L.D.V.); Centro per la Lotta Contro L'Infarto-CLI Foundation, Rome, Italy (F.P., E.R., L.G., A.D.G., V.M.); Division of Cardiology, University of Catania, Italy (A.L.M.); Cardiovascular Department, Università Cattolica Del Sacro Cuore, Rome, Italy (F.B., C.T., I.P.); Division of Cardiology, Misericordia Hospital, Grosseto, Italy (U.L.); Division of Cardiology, Ospedale Civile Ferdinando Veneziale, Isernia, Italy (F.V.); Centro Cardiologico Monzino IRCCS, Milano, Italy (F.F.); Division of Cardiology, Ospedale Brotzu, Cagliari, Italy (A.B.); GVM Care and Research, E.S. Health Science Foundation, Cotignola, Italy (L.T.); and Cardiovascular Research Foundation, New York, NY (G.S.M.).
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000628:therapy*; D000368:Aged; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation*; D058226:Plaque, Atherosclerotic; 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: acute coronary syndrome; percutaneous coronary intervention; prognosis; registries; stents