Author + information
- Received January 16, 2018
- Revision received June 27, 2018
- Accepted June 28, 2018
- Published online August 6, 2018.
- Daisuke Nakamura, MDa,
- William Wijns, MD, PhDb,c,
- Matthew J. Price, MDd,
- Michael R. Jones, MDe,
- Emanuele Barbato, MD, PhDb,
- Takashi Akasaka, MD, PhDf,
- Stephen W.-L. Lee, MD, PhDg,
- Sandeep M. Patel, MDa,
- Setsu Nishino, MD, PhDa,
- Wei Wang, PhDa,
- Ajay Gopinath, PhDa,
- Guilherme F. Attizzani, MDa,
- David Holmes, MDh and
- Hiram G. Bezerra, MD, PhDa,∗ ()
- aHarrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
- bCardiovascular Research Center, OLV Hospital, Aalst, Belgium
- cThe Lambe Institute for Translational Medicine and CURAM, National University of Ireland, Galway, Ireland
- dScripps Clinic, La Jolla, California
- eBaptist Health Lexington, Lexington, Kentucky
- fWakayama Medical University, Wakayama, Japan
- gUniversity of Hong Kong, Queen Mary Hospital, Hospital Authority, Pok Fu Lam, Hong Kong
- hMayo Clinic, Rochester, Minnesota
- ↵∗Address for correspondence:
Dr. Hiram G. Bezerra, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, Ohio 44106.
Objectives This study sought to compare conventional methodology (CM) with a newly described optical coherence tomography (OCT)-derived volumetric stent expansion analysis in terms of fractional flow reserve (FFR)-derived physiology and device-oriented composite endpoints (DoCE).
Background The analysis of coronary stent expansion with intracoronary imaging has used CM that relies on the analysis of selected single cross-sections for several decades. The introduction of OCT with its ability to perform semiautomated volumetric analysis opens opportunities to redefine optimal stent expansion.
Methods A total of 291 lesions treated with post-stent OCT and FFR were enrolled. The expansion index was calculated by using a novel volumetric algorithm and was defined as: ([actual lumen area / ideal lumen area] × 100) for each frame of the stented segment. The minimum expansion index (MEI) was defined as the minimum value of expansion index along the entire stented segment. MEI and conventional lumen expansion metrics were compared for the ability to predict post-stent low FFR (<0.90) and DoCE at 1 year.
Results There was a stronger correlation between MEI and final FFR, compared with CM and final FFR (r = 0.690; p < 0.001) versus (r = 0.165; p = 0.044). MEI was significantly lower in patients with DoCE than those without DoCE (72.18 ± 8.23% vs. 81.48 ± 11.03%; p < 0.001), although stent expansion by CM was similar between patients with and without DoCE (85.05 ± 22.19% and 83.73 ± 17.52%; p = 0.858), respectively.
Conclusions OCT analysis of stent expansion with a newly described volumetric method, but not with CM, yielded data that were predictive of both an acute improvement in FFR-derived physiology and DoCE.
Authors from participating sites report institutional study support from St. Jude Medical. Dr. Wijns has received research grants from Volcano and Boston Scientific; received speaker fees from Abbott Vascular, Biotronik, and MicroPort; is a cofounder, shareholder, and nonexecutive board member of Argonauts Partners; and a past board member of Cardio3Biosciences, now Celyad. Dr. Price has received fees from St. Jude, Boston Scientific, Medtronic, and Terumo. Dr. Jones serves on the Abbott Vascular Speakers Bureau. Dr. Akasaka has received fees from St. Jude Medical Japan, Abbott Vascular Japan, Terumo, and Goodman. Dr. Attizzani has received consulting fees from St. Jude Medical; is a proctor for Edwards Lifesciences and Medtronic; and serves on the Abbott Vascular Speakers Bureau. Dr. Gopinath is an Abbott employee. Dr. Bezerra has received consulting fees from St. Jude Medical, and Abbott Vascular; and is an employee of Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 16, 2018.
- Revision received June 27, 2018.
- Accepted June 28, 2018.
- 2018 American College of Cardiology Foundation
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