Optical coherence tomography predictors of clinical outcomes after stent implantation: the ILUMIEN IV trial.

Autor:	Landmesser U; Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum Charité, Charité-Universitätsmedizin Berlin, Berlin, Germany.; Berlin Institute of Health, Berlin, Germany.; German Centre for Cardiovascular Research, Berlin, Germany., Ali ZA; St. Francis Hospital, Roslyn, NY, USA.; Cardiovascular Research Foundation, New York, NY, USA., Maehara A; Cardiovascular Research Foundation, New York, NY, USA.; Center for Interventional Cardiovascular Care, Columbia University, New York, NY, USA., Matsumura M; Cardiovascular Research Foundation, New York, NY, USA., Shlofmitz RA; St. Francis Hospital, Roslyn, NY, USA., Guagliumi G; IRCCS Galeazzi Sant'Ambrogio Hospital, Milan, Italy., Price MJ; Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, CA, USA., Hill JM; Royal Brompton Hospital, London, UK., Akasaka T; Wakayama Medical University, Wakayama, Japan., Prati F; Saint Camillus International University of Health Sciences, CLI Foundation, Rome, Italy., Bezerra HG; Tampa General Hospital, Tampa, FL., Wijns W; The Lambe Institute for Translational Medehance Spicine and Curam, University of Galway, Galway, Ireland., Leistner D; Department of Medicine, Cardiology, Goethe University Hospital, Frankfurt, Germany.; German Center for Cardiovascular Research (DZHK) Partner Site RheinMain, Frankfurt, Germany., Canova P; Ospedale Papa Giovanni XXIII, Bergamo, Italy., Alfonso F; Cardiology Department, Hospital Universitario de La Princesa, CIBERCV, IIS-IP, Madrid, Spain., Fabbiocchi F; IRCCS Galeazzi Sant'Ambrogio Hospital, Milan, Italy., Calligaris G; Department of Cardiovascular Sciences, University of Milan, Milano, Italy., Oemrawsingh RM; Albert Schweitzer Ziekenhuis, Dordrecht, The Netherlands., Achenbach S; Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany., Trani C; Fondazione Policlinico Universitario A. Gemelli, Rome, Italy., Singh B; Max Super Specialty Hospital, Saket, New Delhi, India., McGreevy RJ; Abbott Vascular, Santa Clara, CA, USA., McNutt RW; Abbott Vascular, Santa Clara, CA, USA., Ying SW; Abbott Vascular, Santa Clara, CA, USA., Buccola J; Abbott Vascular, Santa Clara, CA, USA., Stone GW; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA.
Jazyk:	angličtina
Zdroj:	European heart journal [Eur Heart J] 2024 Nov 14; Vol. 45 (43), pp. 4630-4643.
DOI:	10.1093/eurheartj/ehae521
Abstrakt:	Background and Aims: Observational registries have suggested that optical coherence tomography (OCT) imaging-derived parameters may predict adverse events after drug-eluting stent (DES) implantation. The present analysis sought to determine the OCT predictors of clinical outcomes from the large-scale ILUMIEN IV trial. Methods: ILUMIEN IV was a prospective, single-blind trial of 2487 patients with diabetes or high-risk lesions randomized to OCT-guided versus angiography-guided DES implantation. All patients underwent final OCT imaging (blinded in the angiography-guided arm). From more than 20 candidates, the independent OCT predictors of 2-year target lesion failure (TLF; the primary endpoint), cardiac death or target-vessel myocardial infarction (TV-MI), ischaemia-driven target lesion revascularization (ID-TLR), and stent thrombosis were analysed by multivariable Cox proportional hazard regression in single treated lesions. Results: A total of 2128 patients had a single treated lesion with core laboratory-analysed final OCT. The 2-year Kaplan-Meier rates of TLF, cardiac death or TV-MI, ID-TLR, and stent thrombosis were 6.3% (n = 130), 3.3% (n = 68), 4.3% (n = 87), and 0.9% (n = 18), respectively. The independent predictors of 2-year TLF were a smaller minimal stent area (per 1 mm2 increase: hazard ratio 0.76, 95% confidence interval 0.68-0.89, P < .0001) and proximal edge dissection (hazard ratio 1.77, 95% confidence interval 1.20-2.62, P = .004). The independent predictors of cardiac death or TV-MI were smaller minimal stent area and longer stent length; of ID-TLR were smaller intra-stent flow area and proximal edge dissection; and of stent thrombosis was smaller minimal stent expansion. Conclusions: In the ILUMIEN IV trial, the most important OCT-derived post-DES predictors of both safety and effectiveness outcomes were parameters related to stent area, expansion and flow, proximal edge dissection, and stent length. (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Databáze:	MEDLINE
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