OCT-guided PCI Research Articles

Comparison of intravascular ultrasound-guided with optical coherence tomography-guided percutaneous coronary intervention for left main distal bifurcation lesions: Rationale and design of the ISOLEDS trial

BackgroundPercutaneous coronary intervention (PCI) can provide benefits for anatomically suitable left main coronary artery (LMCA) lesions. When compared to traditional coronary angiography (CAG) -guided PCI, the use of intravascular ultrasound (IVUS) guidance has shown significant long-term prognostic improvements in LMCA PCI. Optical coherence tomography (OCT) offers a higher axial resolution than IVUS. However, there is currently a lack of relevant randomized controlled trials investigating the use of OCT specifically for left main distal bifurcation lesions. MethodsThe ISOLEDS trial is an ongoing multicenter study that aims to compare IVUS-guided PCI with OCT-guided PCI for patients with true LMCA distal bifurcation lesions. This prospective, randomized, controlled, non-inferiority trial will enroll a total of 664 patients with visually-defined Medina 1,1,1 or 0,1,1 classification of left main distal bifurcation lesions. The patients will be randomly assigned in a 1:1 ratio to either IVUS-guided or OCT-guided PCI. The primary endpoint is to assess the occurrence of target lesion failure (TLF) within 12 months after the procedure. After undergoing PCI, patients are required to visit the hospital for a 12-month clinical follow-up. During this clinical assessment, CAG can be performed to evaluate the status of target lesions. DiscussionThe ISOLEDS trial represents the first attempt to compare two distinct intracoronary imaging techniques for guiding PCI in patients with true LMCA distal bifurcation lesions. By evaluating and comparing the outcomes of these two imaging techniques, the trial results will aid operators in selection of the most effective approach for guiding PCI in these patients.

PATIENT WITH CHRONIC CORONARY SYNDROME: USE OF MULTIMODAL IMAGING FOR CORRECT DIAGNOSIS AND TREATMENT

Abstract In the context of CCS, CCTA allows us to discriminate with almost certainty between patients with the absence of disease. In case of a positive test, the characteristics of the plaque allow to stratified risk of developing future events. In doubtful cases it is necessary to resort to a multimodal imaging strategy for the correct diagnosis. We present the case of a 63-year-old hypertensive and dyslipidemic man who started presenting two months ago episodes of asthenia associated with tachycardia and jugular constriction after taking the usual CCB therapy. With a pre-test probability of 26%, a CCTA scan was requested which highlighted a non-calcific fibrous plaque (Image 1) at the level of the middle circumflex inducing a moderate stenosis (Cad-Rads 3). The patient underwent coronary angiography which confirmed this lesion and also highlighted a similar one downstream of the first. (Image 2) The OCT evaluation showed: 7 mm eccentric fibrous proximal plaque with evidence of multiple intimal layers (Healed plaque) in its distal third and with evidence of a medial-intimal flap involving three quadrants in the proximal two thirds (270°), with current intact endothelium and presence of neo-angiogenesis; MLA 2.33 mm² and AS 70%. Picture compatible with healed spontaneous dissection of the vessel. (Image 3) The subsequent 12 mm concentric plaque (360° involvement of the vessel) had a predominantly lipid component with macrophages and fibrous cap of 60 µm, MLA of 2.3mm² and AS 72%. Panel compatible with high risk plaque. (Image 4) It was decided to implant a 3.5x26mm drug-eluting stent through OCT-guided PCI with final MSA of 7.62 mm², stent expansion of 81%, absence of dissections at the edges and residual distal edge plaque with MLA of 7.6 mm². (Image 5). Conclusions Healed plaques are more frequent in patients with CCS and represent a plaque complicated by medial-intimal ulceration subsequently healed by neo-endothelialization. On CCTA they appear as non-calcific fibrous plaques with an intermediate density expressed in Hounsfield Units but the definitive diagnosis can only be obtained using an Intravascular Imaging method (OCT in the case presented). The patient appears asymptomatic after resuming his usual antihypertensive therapy at 30-day FU.

Pharmacoeconomic evaluation of optical coherence tomography for imaging in cardiac interventions

Introduction: OCT is a noninvasive, contactless, optical method that uses infrared light to produce images of blood vessel anatomy, tissue microstructure, and stents during cardiac catheterization. Aim: This review aims to present a cost-effectiveness analysis and budget impact analysis of optical coherence tomography for imaging in patients undergoing cardiac catheterization and percutaneous coronary interventions. Methods: An incomplete economic analysis was chosen to evaluate the cost-effectiveness of OCT, in which only direct medical costs were assessed. The time horizon for estimating the costs and health benefi ts of OCT was one year. In addition, a budget impact analysis was conducted. Results: As a result of the incomplete economic analysis of the costs of OCT-guided PCI, it could be seen that the total cost per patient amounted to BGN 4,954.89. These costs include the unit cost of the device (OCT catheters) – BGN 2,000.00 including VAT, and the weighted average cost of the OCT-guided PCI procedure – BGN 2,954.89. Conclusion: The OCT-guided PCI strategy is associated with higher procedural costs but with more favorable clinical benefi ts, making it a cost-effective option for intravascular imaging in the long term.

Poor prognosis of patients with acute coronary syndrome presenting optical coherence tomography-defined calcified nodule at culprit lesions after emergent percutaneous coronary intervention

Abstract Background Optical coherence tomography (OCT) enables the diagnosis of underlying causes of acute coronary syndrome (ACS). Calcified nodule (CN) is reported to be a rare but important cause of ACS, although its prognostic impact on clinical outcomes after emergent percutaneous coronary intervention (EPCI) remains undetermined. TACTICS registry is an investigator-initiated, prospective, multicenter, observational study to be conducted at 22 hospitals in Japan to clarify the prevalence of underlying causes of ACS defined by OCT (plaque rupture [PR], plaque erosion [PE] and CN) and its impact on clinical outcomes, and assess the feasibility of OCT-guided emergent PCI (UMIN-CTR, ID 000039050). Purpose This study aimed to clarify the prevalence of CN at the culprit lesions in ACS patients and its prognostication after EPCI in a large prospective registry. Methods We assessed 702 patients enrolled in TACTICS registry who underwent OCT assessment of the culprit lesion during EPCI. Advanced chronic kidney disease (CKD) was defined as those with creatinine clearance <30 ml/min/1.73m2. The prevalence of OCT-defined CN and occurrence of MACE, defined as a composite of cardiovascular death, myocardial infarction, heart failure, or ischemia-driven unplanned revascularization at 1 year were compared between patients with and without advanced CKD. Result Patients with advanced CKD was found in 5.4% of a total cohort. The prevalence of CN was 3.0% in patients with non-advanced CKD and 21.1% in those with advanced CKD (p<0.001). In advanced CKD, MACE occurred most frequently in patients with CN (87.5%), followed by plaque rupture (11.8%) and plaque erosion (10.0%) (p<0.001). In Cox hazard analysis, CN was a significant predictor for MACE in advanced CKD (hazard ratio [HR], 12.94 (3.31-50.67), p<0.001). In contrast, CN was not significant predictor for MACE in non-advanced CKD (HR1.931 (0.706-5.281), p=0.200). Conclusion CN is significantly more frequently found at the culprit lesions of ACS in advanced CKD patients. CN was associated with poor outcome in advanced CKD patients.

Poor prognosis after successful primary PCI in STEMI patients with calcified nodule

Abstract Background The prognostic impact of the underlying causes of ST-elevation myocardial infarction (STEMI) diagnosed by optical coherence tomography (OCT) has not been systematically examined in real-world settings. Methods We executed a post-hoc analysis of the TACTICS/TACTICS background registry, an investigator-initiated, multicenter, observational study conducted at 22 Japanese hospitals, involving 1046 STEMI patients (symptom onset within 24 hours) who underwent primary PCI included 441 patients with OCT-guidance. Underlying causes of STEMI (plaque rupture [PR], plaque erosion [PE] and calcified nodule [CN]) were identified in 338 patients using established OCT definition at independent core-laboratory. Major adverse cardiac events (MACE: cardiovascular death, MI, heart failure, or ischemia-driven revascularization) at 1 year were adjudicated by an independent clinical event committee. Results Of 1046 patients with STEMI, 441 (42.2%) underwent OCT-guided primary PCI deemed for analysis. TIMI 3 flow grade was obtained in 95.0% of patients on final angiogram, and optimal post-PCI OCT findings (minimum lumen area ≥4.5 mm2 or ≥70% of the mean reference lumen area) was achieved in 77.9%. The prevalence of PR, PE, and CN was 68.3%, 24.2%, and 3.7%, respectively. One-year MACE occurred most frequently in patients with CN (31.2%), then PR (14.0%) and PE (2.8%) (log-rank P<0.0001). On multivariate Cox regression analysis, the underlying ACS cause was associated with 1-year MACE (CN [HR 9.98, 95%CI 1.99–50.1, p=0.005]; PR [HR 4.84, 95%CI 1.49–15.7, p=0.009]; PE as reference). Conclusion OCT-guided primary PCI for STEMI patients seemed feasible for optimizing PCI and stratifying risk for future MACE.Figure

Abstract 18201: Intracoronary Optical Coherence Tomography versus Intravascular Ultrasound in ST and Non-ST Elevation Myocardial Infarction: A Nation-Wide Analysis

Introduction: Intravascular ultrasound (IVUS) and intracoronary optical coherence tomography (OCT) are the 2 techniques of intracoronary imaging that are currently accessible modalities to precisely measure coronary diameters and characterize morphology of lesions. We aimed to compare the impact of IVUS and OCT on outcomes and 30-day readmission rates following STEMI and NSTEMI. Methods: We queried the National Readmission database (2010-2019) to identify patients with STEMI and NSTEMI, undergoing PCI and compared outcomes and 30-day readmission rates between patients undergoing IVUS-guided PCI and OCT-guided PCI. Multivariable logistic regression was performed to evaluate the odds ratios (OR) of adverse outcomes in the 2 groups Results: Of 67,479 STEMI admissions undergoing ICI-guided PCI, 65,137 underwent IVUS and 2,342 underwent OCT. Patients undergoing OCT compared to IVUS had lower Length of stay (LOS) (OR 0.98 [0.96-0.99], P<0.05). However, there was no significant difference in in-hospital mortality, 30-day readmission rate and 90-day readmission rate. Of 103,901 NSTEMI admissions undergoing ICI-guided PCI, 100,127 underwent IVUS and 3774 underwent OCT. Patients undergoing OCT compared to IVUS had lower LOS (OR 0.95 [0.93-0.98], P<0.001) and 30-day readmission rates (OR 0.84 [0.71-0.99], P<0.05), but no significant differences were found in in-hospital mortality and 90-day readmission rates Conclusions: In acute MI patients undergoing ICI-guided PCI, OCT-guided PCI during index hospitalization is associated with similar outcomes compared to IVUS-guided PCI (except better LOS and 30-day readmission rates in NSTEMI).

Outcomes of Optical Coherence Tomography Compared with Intravascular Ultrasound to Guide Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis of Randomized Control Trials

In the recent years, the alternative intravascular imaging modalities that are most frequently employed to direct and optimize PCI have been intravascular ultrasound (IVUS) and optical coherence tomography (OCT). The comparative effectiveness of OCT-guided vs IVUS-guided PCI is still up for debate. The purpose of this study was to conduct a systematic review and meta-analysis of all available studies comparing OCT-guided versus intravascular ultrasound (IVUS)-guided PCI. Electronic journals searching were performed in PubMed, ScienceDirect, and Cochrane from January 2015 to March 2023 to identify randomized control trial (RCT) studies that compare OCT‐guided PCI to IVUS‐guided PCI. Meta-analyses were performed on included studies and Odds ratio (OR) and 95% Confidence Interval (CI) were estimated using Review Manager v5.4. A total of four RCT enrolling 1316 participants were included in our analysis. There is no statistical significance was observed in the OCT versus IVUS comparison on all cause mortality [OR = 1.75, 95% CI (0.52, 5.88), p = 0.37], cardiovascular mortality [OR = 1.40, 95% CI (0.27, 7.11), p = 0.69], MACE [OR = 1.04, 95% CI (0.63, 1.71), p = 0.88], ST [OR = 0.94, 95% CI (0.16, 5.52), p = 0.95], TLR [OR = 0.77, 95% CI (0.39, 1.50), p = 0.44], and TVR [OR = 1.19, 95% CI (0.68, 2.07), p = 0.54].

New insights into OCT-guided PCI.

New insights into OCT-guided PCI.

Optical coherence tomography-guided versus angiography-guided percutaneous coronary intervention in acute coronary syndrome: a meta-analysis

BackgroundPercutaneous coronary intervention (PCI) is standard of care in patients with acute coronary syndrome (ACS) suitable for interventional revascularization. Intracoronary imaging by optical coherence tomography (OCT) expanded treatment approaches adding diagnostic information and contributing to stent optimization.ObjectivesThis meta-analysis aimed to assess the effects of OCT-guided vs. angiography-guided PCI in treatment of ACS.MethodsA structured literature search was performed. All controlled trials evaluating OCT-guided vs. angiography-guided PCI in patients with ACS were eligible. The primary end point was major adverse cardiac events (MACE).ResultsEight studies enrolling 2612 patients with ACS were eligible. 1263 patients underwent OCT-guided and 1,349 patients angiography-guided PCI. OCT guidance was associated with a 30% lower likelihood of MACE (OR 0.70, 95% CI 0.53–0.93, p = 0.01, I2 = 1%). OCT-guided PCI was also associated with significantly decreased cardiac mortality (OR 0.49, 95% CI 0.25–0.96, p = 0.04, I2 = 0%). There was no detectable difference in all-cause mortality (OR 1.08, 95% CI 0.51–2.31, p = 0.83, I2 = 0). Patients in OCT-guided group less frequently required target lesion revascularization (OR 0.26, 95% CI 0.07–0.95, p = 0.04, I2 = 0%). Analysis of myocardial infarction did not result in significant treatment differences. In subgroup or sensitivity analysis the observed advantages of OCT-guided PCI were not replicable.ConclusionThe evidence suggests that PCI guidance with OCT in ACS decreases MACE, cardiac death and target lesion revascularization compared to angiography. On individual study level, in subgroup or sensitivity analyses these advantages were not thoroughly replicable.

Plasma asymmetric dimethylarginine is associated with vulnerable plaque and long-term outcomes in stable coronary artery disease

Asymmetric dimethylarginine (ADMA) is considered to be an atherogenic molecule. We aimed to investigate the relationship between ADMA and plaque vulnerability assessed by optical coherence tomography (OCT) in patients with stable coronary artery disease (CAD). Two hundred and forty-five patients with stable CAD undergoing OCT-guided percutaneous coronary intervention were included in this study and were divided into two groups according to their ADMA levels. Micro-vessel, macrophage accumulation, thin-cap fibroatheroma, intra-plaque calcium and lipid core content, and vulnerable score (VS) were evaluated by OCT analysis. The patients with higher ADMA levels had significantly higher calcium and lipid content (p < 0.001, respectively). There were significantly more micro-vessel and macrophage (32.8%, p = 0.004 and 52.5%, p < 0.001, respectively) and higher VS (87.7 ± 17.6, p < 0.001) in the higher ADMA group. Moreover, plasma ADMA level was significantly correlated with the intra-plaque lipid, calcium content and VS (p < 0.001, respectively). Plasma ADMA level was identified as an independent predictor of future adverse cardiovascular events, following OCT-guided PCI. In patients with stable CAD, higher plasma ADMA levels were significantly associated with the presence of intra-plaque lipid, calcification, vulnerable plaque, and poor long-term outcomes.

OCT-guided left-main PCI, a retrospective single-center analysis

Abstract Funding Acknowledgements Type of funding sources: None. Background It is known that PCI is associated with non-optimal stent implantation utilizing angiography for only left main lesions as well as for bifurcation lesions and is characterised by a high risk of adverse long-term effects. The use of OCT for the left main stent makes it easier to enhance the effective implantation of stents and enhance the results of patients. Methods A single-center randomised study was performed to demonstrate the benefit of stent implantation under OCT control in the left main bifurcation lesions compared to standard implantation under angiographic control. The follow-up period was 1 year, and the study included 68 patients with 1:1 randomization. The final composite points were: cardiac death, ischaemia, or myocardial infarction. All patients were elective, with moderate to high-functional class of angina pectoris. PCI was done using one or two stents, using OCT or without OCT to perform kissing dilation and proximal optimization technique. Results As a result of the data review of 68 patients with or without OCT using PCI of left main bifurcation lesions, the primary endpoint parameters in the non-OCT group were 17.8% and 6% for the OCT group. In 43.1 % of cases, a single-stent technique was used rather than a two-stent when using OCT. In the OCT group, additional stent optimisation is 40% more common. In 96.7 % of cases, a 9-month follow-up in the OCT group showed complete or partial endothelization of the stent struts, allowing earlier termination of DAPT, which is critical in patients at high risk for significant bleeding. Conclusions The perioperative results of PCI for left main bifurcation can be improved by the use of OCT using regulated factors for optimal stent implantation. As a result, in patients with atrial fibrillation and a high risk of painful bleeding, the long-term effects of treatment are increased , the time to take DAPT is decreased and the number of implantable stents is decreased, which is significant.

Abstract 9903: CT Number Predicts Calcium Thickness in Optical Coherence Tomography Guided Percutaneous Coronary Intervention

Introduction: Optical coherence tomography (OCT) can assess calcium thickness, which is the key factor for predicting good stent expansion in calcified lesions. However, OCT can underestimate coronary calcium severity due to its penetration limitation and lipid accumulation while multi-slice computed tomography (CT) allows for a noninvasive assessment of coronary calcification. This study aimed to compare cross-sectional CT and OCT images for the assessment of calcification. Methods and Results: We investigated 33 lesions using coronary CT and OCT for the assessment of calcification. Of the 33 lesions, 211 regions of interest were set every 30 degrees in both the CT and OCT cross-sectional images. In 88 (41.7%) regions of interest with CT-detected calcium, the thickness of calcium was not detectable in the corresponding OCT image due to limited penetration, lipid attenuation, and guidewire artifact. There was an excellent correlation between CT number and thickness of calcium in the corresponding OCT image (R=0.797, P&lt;0.001). Receiver-operator curve analysis also showed fair discrimination between calcium thickness less than 500 μm and 500 μm or higher at a CT number of 1021 HU. Conclusions: Cross-sectional CT imaging could complement the underestimation of calcium severity in OCT-guided PCI, predicting the calcium thickness by CT number.

Abstract 11770: Clinical Outcomes of Optical Coherence Tomography-Guided Compared With Intravascular Ultrasound-Guided in Low-Risk Percutaneous Coronary Intervention: A Meta-Analysis

Background: Axial resolution provided by optical coherence tomography (OCT) is 10 times higher compared with intravascular ultrasound (IVUS), hence OCT could detect fine details such as edge dissections and tissue coverage of stent struts which may be missed by IVUS imaging. Given the lack of robust comparative data, utilization of IVUS or OCT in PCI guidance is mainly based on the operator experience. Recently, multiple studies have compared clinical outcomes between OCT-guided versus IVUS-guided in PCI, thus we performed this meta-analysis. Methods: We conducted a meta-analysis of all studies evaluating the clinical outcomes of OCT-guided versus IVUS-guided in low-risk PCI. Studies that included patients with left main disease, bifurcation lesions, long lesions, in-stent stenosis, and patients with history of coronary artery bypass grafting were all excluded. Our primary outcome was major cardiac adverse events (MACE). Secondary outcomes consisted of all-cause death, myocardial infarction (MI), stent thrombosis (ST), and target lesion revascularization (TLR). Results: Four RCTs and one propensity-matched observational study were included, with a total of 1,544 patients and a median weighted follow-up period of 1.26 years. Out of the total population, 51% were in the OCT arm and 49% in the IVUS arm. Our pooled analysis showed a similar risk of MACE (OCT 5.0% vs IVUS 4.7%, p=0.90), risk of all-cause death (OCT 2.7% vs IVUS 1.7%, p=0.44), MI (OCT 1.5% vs IVUS 1.3%, p=0.76), ST (OCT 0.3% vs IVUS 0.4%, p=0.66) and TLR (OCT 2.2% vs IVUS 2.6%, p=0.58) between the two groups (Figures 1). Heterogeneity was low in all outcomes (I 2 =0). Conclusion: OCT-guided PCI has similar long term clinical outcomes when compared to IVUS-guided PCI in low-risk patients. RCTs with a larger population and longer follow-up periods are needed to confirm these results.

Optical coherence tomography to guide percutaneous coronary intervention of the left main coronary artery: the LEMON study.

Intravascular ultrasound (IVUS)-guided PCI improves the prognosis of left main stem (LMS) PCI and is currently recommended by international guidelines. Although OCT resolution is greater than that of IVUS, this tool is not yet recommended in LMS angioplasty due to the absence of data. This pilot study aimed to analyse the feasibility, safety and impact of OCT-guided LMS PCI. This prospective, multicentre trial investigated whether patients might benefit from OCT-guided PCI for mid/distal LMS according to a pre-specified protocol. The primary endpoint was procedural success defined as follows: residual angiographic stenosis <50% + TIMI 3 flow in all branches + adequate OCT stent expansion (LEMON criteria). Seventy patients were included in the final analysis (median age: 72 [64-81] years, 73% male). The OCT pre-specified protocol was applied in all patients. The primary endpoint was achieved in 86% of subjects. Adequate stent expansion was observed in 86%, significant edge dissection in 30% and residual significant strut malapposition in 24% of the cases. OCT guidance modified the operators' strategy in 26% of the patients. The rate of one-year survival free from major adverse clinical events was 98.6% (97.2-100). This pilot study is the first to report the feasibility and performance of OCT-guided LMS PCI according to a pre-specified protocol.

Relationship between stent expansion and fractional flow reserve after percutaneous coronary intervention: a post hoc analysis of the DOCTORS trial.

The best criteria for adequate stent expansion assessment by intracoronary imaging remain debated and their correlation with post-PCI FFR values is unknown. This study aimed to analyse the relationship between stent expansion criteria using optical coherence tomography (OCT) analysis and the final PCI functional result. This post hoc analysis of the DOCTORS study included non-ST-elevation segment ACS patients undergoing OCT-guided PCI. The procedure functional result was assessed by the measurement of fractional flow reserve (FFR). Stent expansion was assessed on OCT runs according to the DOCTORS criteria and ILUMIEN III criteria. The study included N=116 patients (age: 60.8±11.5 years; male gender: 71%). The final expansion was considered optimal in 10%, acceptable in 9% and unacceptable in 81% of the stents according to ILUMIEN III criteria, although being successful in 70% of the patients according to the DOCTORS criteria. Hypertension and larger proximal reference segment dimension were independent predictors of inadequate device ILUMIEN III expansion. FFR values were, respectively, 0.93 (0.91-0.95) versus 0.95 (0.92-0.97) in patients with optimal+acceptable versus unacceptable ILUMIEN III expansion (p=0.22), 0.94 (0.91-0.97) versus 0.95 (0.93-0.97) in patients with optimal versus non-optimal DOCTORS expansion (p=0.23), and 0.95 (0.92-0.97) versus 0.92 (0.90-0.95) in patients with minimal stent area ≥4.5 mm2 versus <4.5 mm2 (p=0.03). In this selected population, no relationship was observed between optimal stent expansion according to ILUMIEN III or DOCTORS OCT criteria and final post-PCI FFR values.

Morphological plaque characteristics and clinical outcomes of acute coronary syndrome patients with a cancer history

Abstract Background Although previous studies have reported that patients with a history of cancer have 2–3 times higher risks for acute coronary syndrome (ACS), morphological culprit plaque characteristics in ACS patients with a cancer history and their relations with clinical outcomes remain unknown. Methods The Kobe University ACS-OCT registry is a multi-center registry of consecutive ACS patients who underwent OCT-guided emergent PCI in Japanese four centers. All patients were categorized into the patients without a history of cancer (non-cancer), those with a history of cancer who diagnosed more than one year before ACS (historical), and those with ongoing cancer treatment or diagnosis within one year before ACS (current). ACS culprit lesions were classified into plaque rupture (PR), plaque erosion (PE), and calcified nodule (CN) according to morphological features by OCT and clinical events were collected after the onset of ACS. Results Among 436 patients, 63 patients (14.4%) had a history of cancer or ongoing treatment of cancer (cancer patients). Cancer patients were significantly older than non-cancer patients (73.4±9.4 vs. 66.9±12.9, p=0.001), and non-ST segment elevation ACS was more frequently observed in cancer patients than in non-cancer patients (57.1% vs. 43.2%, p=0.039). Regarding the ACS culprit lesion, the frequency of PR was significantly lower and the frequencies of PE and CN were significantly higher in the cancer patients than in the non-cancer patients (Figure A1). The cumulative incidence of major adverse cardiovascular event (MACE: composite of cardiac death, non-fatal myocardial infarction, and any revascularization, stroke, and heart failure with admission) after the onset of ACS in cancer patients was significantly higher than that in the non-cancer patients (Figure B1). When the cancer patients were categorized into the historical and the current cancer patients, the frequency of PE was higher in the current and the historical cancer patients than the non-cancer patients. Also, the incidence of CN was significantly higher in the historical cancer patients than others (Figure A2). The cumulative incidence of MACE was significantly higher in the current cancer patients, followed by historical and non-cancer patients (Figure B2). Cox regression analyses demonstrated that the non-PR lesion (hazard ratio (HR) 0.65, 0.46–0.94, p=0.021), patients with multivessel disease (HR 2.55, 1.79–3.64, p&amp;lt;0.001), older patients (HR 1.02, 1.00–1.03, p=0.043) were independently associated with MACE after ACS. Moreover, multivariate analysis demonstrated that cancer history (HR 4.64, 2.34–9.21, p&amp;lt;0.001) and non-ST segment elevation ACS (HR 0.66, 2.34–9.21, p=0.038) were independently associated with non-PR lesion. Conclusions The present study revealed the difference in morphological plaque characteristics between cancer and non-cancer patients, which might explain potential underlying mechanisms for worse outcomes in cancer patients. Funding Acknowledgement Type of funding source: None

Quantification of calcium volume by coronary CT compared to OCT

Abstract Background Coronary artery calcifications are frequently observed in patients referred for cardiac catheterization. Using OCT, the calcified volume can be determined. CT is a sensitive non-invasive tool to detect coronary artery calcifications and may be useful to guide percutaneous coronary intervention. Purpose The aim of the study was to investigate the accuracy of CT-derived calcium volume with OCT as a reference in patients undergoing PCI. Methods 66 calcified plaques (32 vessels) from 31 patients undergoing OCT-guided PCI with coronary CT angiography acquired as a standard of care were included. Coronary CT angiography and OCT images were matched using fiduciary points. Calcified plaques were reconstructed in three dimensions to calculate calcium volume. A Passing-Bablok regression analysis and the Bland-Altman method were used to assess agreement between imaging modalities. Results 27 left anterior descending arteries and 5 right coronary arteries were analyzed. Median calcium volume by CT angiography and OCT were 18.23 mm 3 [IQR 8.09, 36.48] and 10.03 mm 3 [IQR 3.6, 22.88]. The Passing-Bablok analysis showed a proportional difference without a systematic difference (Coefficient A 0.08, 95% CI: −1.37 to 1.21, Coefficient B 1.61, 95% CI: 1.45 to 1.84); with a mean difference of 9.69 mm3 (LOA −10.2 mm 3 to 29.6 mm 3). No significant differences were observed for MLA: median value for CT 2.84 mm2 [IQR 2.03, 3.74] and for OCT 2.55 mm2 [IQR 1.91, 4.43]. Conclusions Coronary CT angiography volumetric calcium evaluation overestimates calcium volume by 60% compared to OCT. Accounting for CT overestimation may allow for appropriate interpretation of calcific burden in the non-invasive setting. Coronary CT angiography may emerge as a tool to quantify calcium burden for invasive procedural planning. Calcium burden comparison CT vs OCT Funding Acknowledgement Type of funding source: None

Early vascular healing following bioresorbable-polymer sirolimus-eluting stent implantation in comparison with durable-polymer everolimus-eluting stent: sequential optical coherence tomography study

Abstract Background Orsiro ultrathin-strut bioresorbable-polymer sirolimus-eluting stent (BP-SES) might facilitate early vascular healing responses that seems to be associated with improved long-term clinical outcomes. We compared the early vascular healing responses to BP-SES and Xience durable-polymer everolimus-eluting stent (DP-EES) in patients with chronic coronary syndrome (CCS) using optical coherence tomography (OCT). Methods A total of 40 patients with CCS receiving OCT-guided PCI were included. 20 patients were assigned to BP-SES, and 20 to DP-EES. OCT was performed immediately after stent placement (post-procedure) and at 1 month follow-up. Struts were recorded as uncovered if any part was visibly exposed in the lumen or covered if a layer of tissue covered all reflecting surfaces. The incidence of intrastent thrombus (IS-Th) and irregular protrusion (IRP) were also assessed. Results At 1 month, the percentage of uncovered struts was significantly lower in the BP-SES compared with the DP-EES (2.8±1.6% vs. 5.8±1.8%, respectively; p&amp;lt;0.001), and that of malapposed struts was similar between both groups (2.5±3.1% vs. 2.4±2.2%; p=0.76). There were no differences in the incidence of IS-Th (65.0% vs. 55.0% at post-procedure; p=0.54, 30.0% vs. 35.0% at 1 month; p=0.75) and IRP (30.0% vs. 25.0% at post-procedure; p=0.74). IRP had completely resolved at 1 month in both groups. Conclusion Early vascular healing response to Orsiro BP-SES implantation was revealed in CCS patients at 1 month compared with Xience DP-EES. Orsiro BP-SES may have a potential to shorten the dual antiplatelet therapy duration. Funding Acknowledgement Type of funding source: None

Comparison of Stent Expansion Using a Volumetric Versus the Conventional Method Through Optical Coherence Tomography in an All-Comers Population

IntroductionA volumetric approach to measure stent expansion derived from optical coherence tomography (OCT) is superior in regards to clinical outcomes when compared to the conventional method. The current software already performs a semi-automatic assessment and it is available as a clinical tool, however data is still scarce. We evaluated the stent expansion analysis that uses a volumetric vessel model, called minimum expansion index – MEI and compared to the conventional model, which utilizes the minimum stent area expansion (MSAx) indexed to the references, and its potential impact on procedural decision-making strategy in percutaneous coronary intervention. MethodsThis was a prospective, all-comers single center study, from all patients undergoing OCT-guided PCI between September 2018 and May 2019. We utilized the APTIVUE™ OPTIS 5.2 software (Abbott, Santa Clara, CA) to evaluate MEI and MSAx measurements after reference adjustments. ResultsWe included 100 patients with mean age of 64 ± 12.5 years, 68% were men, and the main arteries analyzed through OCT were LAD (48%), RCA (31%) and LCx (21%). The mean MEI was 77.6% ± 16.7% and the mean MSAx was 71.6% ± 16.9%. MEI location differed from MSAx in 70% of cases, and in those cases the mean distance between MEI and MSAx was 15.3 mm ± 12.4 mm. In 53% of the times, the stent underexpansion based on MEI was located proximally to the MSAx by 18.1 mm ± 11.8 mm. Furthermore, in 42% of the total cases, MEI would change the intervention strategy based on the stent underexpansion being in a different location ≥10 mm in comparison to MSAx (34%) associated with the discrepancy between expansion indexes for MEI and MSAx (22%). ConclusionWe concluded that MEI location did not correlate to the conventional MSAx in two thirds of the cases. Moreover, compared to MEI, the MSAx assessment yielded lower expansion values in different stent positions, potentially changing the appropriate post-stent optimization, which thus would impact the decision-making strategy in almost half of the patients.

P3577Predictors analysis of restenosis in calcified nodule with OCT-guided PCI

Abstract Background Recent reports show that stenting for coronary calcified nodule (CN) resulted in frequent in-stent restenosis, however, its predictors are unclear. Method 117 consecutive calcified nodule lesions which underwent optical coherence tomography (OCT)-guided PCI were analyzed between January 2013 and March 2018. We investigated baseline characteristics and OCT parameter in CN site (Arc of CN, Lumen area and Symmetry index before and after PCI). Result CN site in-stent restenosis was seen 35 lesions (29.9%). Baseline characteristics was significantly different between restenosis group and non-restenosis group (Age; 68.9y.o vs. 73.3y.o, p=0.01, diabetes mellitus; 80.0% vs. 57.3%, Chronic Kidney Disease (CKD); 74.3% vs. 36.6%, Hemodialysis; 54.3% vs. 12.2%). Arc of CN before PCI in restenosis group was larger than that in non-restenosis group (122.7 vs. 110.0 degrees, p=0.01). Post stent symmetry index in restenosis group was smaller than that in non-restenosis group (0.64 vs. 0.75, p&lt;0.01). Conclusion Younger patients, diabetes mellitus, CKD, hemodialysis, arc of CN before PCI, post stent symmetry index may be predictors of CN site restenosis.