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

Landmesser U, Ali ZA, Maehara A, Matsumura M, Shlofmitz RA, Guagliumi G, Price MJ, Hill JM, Akasaka T, Prati F, Bezerra HG, Wijns W, Leistner D, Canova P, Alfonso F, Fabbiocchi F, Calligaris G, Oemrawsingh RM, Achenbach S, Trani C, Singh B, McGreevy RJ, McNutt RW, Ying SW, Buccola J, Stone GW (2024)

Publication Type: Journal article

Publication year: 2024

Journal

Book Volume: 45

Pages Range: 4630-4643

Journal Issue: 43

DOI: 10.1093/eurheartj/ehae521

Abstract

Background and Observational registries have suggested that optical coherence tomography (OCT) imaging-derived parameters may predict Aims 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.

Authors with CRIS profile

Involved external institutions

Tampa General Hospital United States (USA) (US) Istituto Ortopedico Galeazzi Italy (IT) Charité - Universitätsmedizin Berlin Germany (DE) St. Francis Hospital United States (USA) (US) Cardiovascular Research Foundation United States (USA) (US) Scripps Health United States (USA) (US) Royal Brompton Hospital United Kingdom (GB) Wakayama Medical University Japan (JP) Saint Camillus International University of Health Sciences (UniCamillus) Italy (IT) University of Galway (NUIG) / Ollscoil na Gaillimhe Ireland (IE) Universitätsklinikum Frankfurt am Main (KGU) Germany (DE) Azienda Ospedaliera Papa Giovanni XXIII Italy (IT) Hospital Universitario de La Princesa Spain (ES) Fondazione Policlinico Universitario Agostino Gemelli IRCCS Italy (IT) Abbott Vascular International BVBA United States (USA) (US) Icahn School of Medicine at Mount Sinai United States (USA) (US) Università degli studi di Milano Italy (IT) Albert Schweitzer Ziekenhuis Netherlands (NL)

How to cite

APA:

Landmesser, U., Ali, Z.A., Maehara, A., Matsumura, M., Shlofmitz, R.A., Guagliumi, G.,... Stone, G.W. (2024). Optical coherence tomography predictors of clinical outcomes after stent implantation: the ILUMIEN IV trial. European Heart Journal, 45(43), 4630-4643. https://doi.org/10.1093/eurheartj/ehae521

MLA:

Landmesser, Ulf, et al. "Optical coherence tomography predictors of clinical outcomes after stent implantation: the ILUMIEN IV trial." European Heart Journal 45.43 (2024): 4630-4643.

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