International journal of cardiology · 2026
Impact of absolute stent expansion on two-year clinical outcomes after PCI in patients with acute coronary syndrome: Results from the OCT-guided PCI registry (TACTICS registry).
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Yamamoto Myong Hwa, Mizukami Takuya, Mori Hiroyoshi, Kobayashi Nobuaki, Takano Masamichi, Kondo Seita, Sugiyama Tomoyo, Kakuta Tsunekazu, Wakabayashi Kohei, Suwa Satoru, Dohi Tomotaka, Suzuki Hiroshi, Kimura Shigeki, Yamaguchi Masao, Nakamura Sunao, Naganuma Toru, Higuma Takumi, Yamaguchi Junichi, Yonetsu Taishi, Ikari Yuji, Yamashita Jun, Kondo Takeshi, Honye Junko, Ashikaga Takashi, Ochiai Masahiko, Mitsumata Kaneto, Yasuhara Sakiko, Otake Hiromasa, Hibi Kiyoshi, Nanasato Mamoru, Shinke Toshiro, TACTICS Investigators
Аннотация
BACKGROUND: Stent expansion is a crucial determinant of chronic coronary syndrome outcomes; however, its clinical impact and factors limiting optimal expansion in acute coronary syndrome (ACS) treated with optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) remain unclear.
METHODS: This post-hoc analysis of the prospective, multicenter TACTICS registry included 581 patients with OCT-identified atherothrombotic ACS. Suboptimal OCT findings were defined as minimum stent area (MSA) ≤ 4.5 mm2, MSA < 70% of the mean reference lumen area, reference lumen narrowing, stent-edge dissection, stent malapposition, or tissue protrusion. The primary endpoint was 2-year device-oriented cardiovascular events (DoCE)-cardiovascular death, target-vessel myocardial infarction (TVMI), or ischemia-driven target lesion revascularization (TLR)-adjudicated by an independent committee.
RESULTS: DoCE occurred in 5.3% of patients, and among suboptimal OCT parameters, only MSA ≤ 4.5 mm2 was associated with DoCE (hazard ratio, 2.31; 95% confidence interval 1.14-4.68; P = 0.020). Patients with MSA ≤ 4.5 mm2 had a higher incidence of DoCE than those with MSA > 4.5 mm2 (8.9% vs. 4.0%; log-rank P = 0.017), mainly driven by ischemia-driven TLR (5.1% vs. 1.9%; log-rank P = 0.032), with a trend toward higher incidence of TVMI (2.5% vs. 0.7%; log-rank P = 0.069). In multivariable logistic regression analysis, independent predictors of MSA ≤ 4.5 mm2 were smaller distal reference lumen area, maximum calcium arc ≥180°, and non-ST-segment elevation myocardial infarction.
CONCLUSION: In patients with ACS undergoing OCT-guided PCI, an MSA ≤ 4.5 mm2 was independently associated with higher DoCE risk. Predictors of suboptimal stent expansion may underlie the increased risk of adverse outcomes despite OCT guidance.
CLINICAL TRIAL REGISTRATION: URL: https://www.umin.ac.jp/ctr/index.htm; unique identifier: UMIN000039050.
METHODS: This post-hoc analysis of the prospective, multicenter TACTICS registry included 581 patients with OCT-identified atherothrombotic ACS. Suboptimal OCT findings were defined as minimum stent area (MSA) ≤ 4.5 mm2, MSA < 70% of the mean reference lumen area, reference lumen narrowing, stent-edge dissection, stent malapposition, or tissue protrusion. The primary endpoint was 2-year device-oriented cardiovascular events (DoCE)-cardiovascular death, target-vessel myocardial infarction (TVMI), or ischemia-driven target lesion revascularization (TLR)-adjudicated by an independent committee.
RESULTS: DoCE occurred in 5.3% of patients, and among suboptimal OCT parameters, only MSA ≤ 4.5 mm2 was associated with DoCE (hazard ratio, 2.31; 95% confidence interval 1.14-4.68; P = 0.020). Patients with MSA ≤ 4.5 mm2 had a higher incidence of DoCE than those with MSA > 4.5 mm2 (8.9% vs. 4.0%; log-rank P = 0.017), mainly driven by ischemia-driven TLR (5.1% vs. 1.9%; log-rank P = 0.032), with a trend toward higher incidence of TVMI (2.5% vs. 0.7%; log-rank P = 0.069). In multivariable logistic regression analysis, independent predictors of MSA ≤ 4.5 mm2 were smaller distal reference lumen area, maximum calcium arc ≥180°, and non-ST-segment elevation myocardial infarction.
CONCLUSION: In patients with ACS undergoing OCT-guided PCI, an MSA ≤ 4.5 mm2 was independently associated with higher DoCE risk. Predictors of suboptimal stent expansion may underlie the increased risk of adverse outcomes despite OCT guidance.
CLINICAL TRIAL REGISTRATION: URL: https://www.umin.ac.jp/ctr/index.htm; unique identifier: UMIN000039050.