ISR vs De Novo Lesion Treatment During OCT-Guided PCI: Insights From the LightLab Initiative.

Autor:	Bergmark BA; CTO/Complex Coronary Intervention Program, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.; Thrombolysis in Myocardial Infarction (TIMI) Study Group, Boston, Massachusetts., Golomb M; Hadassah Hebrew University Medical Center, Tel Aviv, Israel., Kuder JF; Thrombolysis in Myocardial Infarction (TIMI) Study Group, Boston, Massachusetts., Buccola J; Abbott Vascular, Santa Clara, California., Wollmuth J; Providence St. Vincent Hospital, Portland, Oregon., Lopez J; Loyola University Medical Center, Maywood, Illinois., Rauch J; Albert Einstein College of Medicine, New York, New York., Chehab BM; Ascension Via Christi Hospital, University of Kansas, Wichita, Kansas., Rapoza R; Abbott Vascular, Santa Clara, California., West NEJ; Abbott Vascular, Santa Clara, California., Croce KJ; CTO/Complex Coronary Intervention Program, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Jazyk:	angličtina
Zdroj:	Journal of the Society for Cardiovascular Angiography & Interventions [J Soc Cardiovasc Angiogr Interv] 2023 Aug 12; Vol. 2 (6Part A), pp. 101118. Date of Electronic Publication: 2023 Aug 12 (Print Publication: 2023).
DOI:	10.1016/j.jscai.2023.101118
Abstrakt:	Background: Long-term outcomes after percutaneous coronary intervention (PCI) for in-stent restenosis (ISR) are poor, yet limited granular procedural data exist evaluating lesion assessment, vessel treatment, and acute procedural outcomes. Methods: The LightLab Initiative was a multicenter, prospective, observational study with contemporaneous procedural data collection during PCI procedures. Data were collected during PCIs performed by 48 interventional cardiologists at 17 US hospitals (2019-2021). Optical coherence tomography (OCT) was performed pre-PCI for lesion assessment and post-PCI for stent optimization, and results were compared between ISR and de novo lesion PCI. Results: In total, 2592 OCT-guided PCIs involving 2944 lesions were included, of which 458 procedures (17.7%) were ISR PCI. Compared with de novo lesion PCI, ISR lesions were more commonly type C (64.8% vs 52.9%) and performed via femoral artery access (46.4% vs 37.7%). Use of OCT changed operator assessment and treatment decisions more frequently in ISR PCI (94.2% vs 85.2%; P = .002). Scoring balloons (21.8% vs 2.5%), cutting balloons (16.4% vs 3.4%), and atherectomy (26.3% vs 9.9%) were used more commonly in ISR PCI (all P < .0001), and ISR PCI procedures were longer (62 vs 51 min). Moreover, the final achieved minimum stent area and percent expansion (4.4 vs 5.1 mm 2 and 80% vs 83%, respectively; both P < .0001) were lower in ISR PCI. Conclusions: In this real-world cohort of patients who underwent OCT-guided PCI, ISR procedures were longer and final minimum stent area and percent expansion were lower despite greater use of advanced lesion modification. OCT frequently altered physician decision making, emphasizing its utility in potentially reducing recurrent stent failure in this high-risk population. (© 2023 The Author(s).)
Databáze:	MEDLINE
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