Author + information
- Patrick C. Magnus1,
- John E. Jayne1,
- Hector M. Garcia-Garcia2,
- Swart Michael3,
- Gerrit-Anne van Es4,
- Jan Tijssen3 and
- Aaron V. Kaplan1
IVUS guided stent deployment using validated criteria (MUSIC) has been shown to improve outcomes. However, for the practicing interventionalist (PI) without core lab support, the utility of IVUS is often limited by difficulty interpreting images. Optical Coherence Tomography (OCT) is a new intra-coronary imaging modality, which yields higher image resolution compared with IVUS. However, the consistency and accuracy with which PI’s interpret OCT images has not been fully evaluated or compared with IVUS.
We hypothesized that, compared with IVUS, PIs experienced with both imaging techniques would interpret OCT images with less deviation from core lab readings and would more reliably assess the MUSIC criteria.
Following stent placement in 5 consecutive patients meeting inclusion criteria, OCT and IVUS images of the stented segment using automated pullbacks were obtained. Image sets were screened by the core lab, and those determined to be adequate quality were then reviewed by 11 PIs from both academic and non-academic practices. The PIs assessed stent expansion and symmetry, reference vessel and in-stent cross-sectional area (CSA) and diameter, and stent strut apposition. Their interpretations were (pairwise) compared for inter-observer agreement. For each pair of PIs, we calculated the % agreement with IVUS and OCT. We also calculated the % agreement of each PI with the corelab.
The inter-observer agreement for obtaining the MUSIC criteria using IVUS was 80.4% compared to 81.1% using OCT (p=0.78). Using the corelab as a reference, the PIs obtained an agreement of 72.7% using IVUS vs. 67.3% using OCT (p=0.43). Despite differences in the individual components of the MUSIC criteria between techniques and between PIs and corelab, they did not affect the overall results.
Although MUSIC criteria was previously validated with IVUS, OCT provides similar results in the assessment of stent deployment when using the MUSIC criteria. When compared to IVUS, there was greater agreement of PI OCT interpretation with core lab determinations for each Music Criteria component (expansion, symmetry and apposition).