Peer-Reviewed Journal Details
Mandatory Fields
Wijns, W;Shite, J;Jones, MR;Lee, SWL;Price, MJ;Fabbiocchi, F;Barbato, E;Akasaka, T;Bezerra, H;Holmes, D
2015
December
European Heart Journal
Optical coherence tomography imaging during percutaneous coronary intervention impacts physician decision-making: ILUMIEN I study
Published
28 ()
Optional Fields
FRACTIONAL FLOW RESERVE INTRAVASCULAR ULTRASOUND MYOCARDIAL-INFARCTION CLINICAL-OUTCOMES STENT TRIALS DEFINITIONS ANGIOGRAPHY DISEASE STENOSES TAXUS
36
3346
3355
Aims ILUMIEN I is the largest prospective, non-randomized, observational study of percutaneous coronary intervention (PCI) procedural practice in patients undergoing intra-procedural pre- and post-PCI fractional flow reserve (FFR) and optical coherence tomography (OCT). We report on the impact of OCT on physician decision-making and the association with post-PCI FFR values and early clinical events. Methods and results Optical coherence tomography and documentary FFR were performed pre- and post-PCI in 418 patients (with 467 stenoses) with stable or unstable angina or NSTEMI. Based on pre-PCI OCT, the procedure was altered in 55% of patients (57% of all stenoses) by selecting different stent lengths (shorter in 25%, longer in 43%). After clinically satisfactory stent implantation using angiographic guidance, post-PCI FFR and OCT were repeated. Optical coherence tomography abnormalities deemed unsatisfactory by the implanting physician were identified: 14.5% malapposition, 7.6% under-expansion, 2.7% edge dissection and prompted further stent optimization based on OCT in 25% of patients (27% of all stenoses) using additional in-stent post-dilatation (81%, 101/124) or placement of 20 new stents (12%). Optimization subgroups were identified post hoc: stent placement without reaction to OCT findings (n = 137), change in PCI planning by pre-PCI OCT (n = 165), post-PCI optimization based on post-PCI OCT (n = 41), change in PCI planning, and post-PCI optimization based on OCT (n = 65). Post-PCI FFR values were significantly different (P = 0.003) between optimization groups (lower in cases with pre- and post-PCI reaction to OCT) but no longer different after post-PCI stent optimization. MACE events at 30 days were low: death 0.25%, MI 7.7%, repeat PCI 1.7%, and stent thrombosis 0.25%. Conclusion Physician decision-making was affected by OCT imaging prior to PCI in 57% and post-PCI in 27% of all cases.
0195-668X
10.1093/eurheartj/ehv367
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