Optical coherence tomography imaging during percutaneous coronary intervention impacts physician decision-making: ILUMIEN i study

William Wijns, Junya Shite, Michael R. Jones, Stephen W.L. Lee, Matthew J. Price, Franco Fabbiocchi, Emanuele Barbato, Takashi Akasaka, Hiram Bezerra, David Holmes

Research output: Contribution to journalArticle

96 Scopus citations

Abstract

Aims ILUMIEN I is the largest prospective, non-randomized, observational study of percutaneous coronary intervention (PCI) procedural practice in patients undergoing intra-procedural pre-and post-PCI fractional flow reserve (FFR) and optical coherence tomography (OCT). We report on the impact of OCT on physician decision-making and the association with post-PCI FFR values and early clinical events. Methods and results Optical coherence tomography and documentary FFR were performed pre-and post-PCI in 418 patients (with 467 stenoses) with stable or unstable angina or NSTEMI. Based on pre-PCI OCT, the procedure was altered in 55% of patients (57% of all stenoses) by selecting different stent lengths (shorter in 25%, longer in 43%). After clinically satisfactory stent implantation using angiographic guidance, post-PCI FFR and OCT were repeated. Optical coherence tomography abnormalities deemed unsatisfactory by the implanting physician were identified: 14.5% malapposition, 7.6% under-expansion, 2.7% edge dissection and prompted further stent optimization based on OCT in 25% of patients (27% of all stenoses) using additional in-stent post-dilatation (81%, 101/124) or placement of 20 new stents (12%). Optimization subgroups were identified post hoc: stent placement without reaction to OCT findings (n = 137), change in PCI planning by pre-PCI OCT (n = 165), post-PCI optimization based on post-PCI OCT (n = 41), change in PCI planning, and post-PCI optimization based on OCT (n = 65). Post-PCI FFR values were significantly different (P = 0.003) between optimization groups (lower in cases with pre-and post-PCI reaction to OCT) but no longer different after post-PCI stent optimization. MACE events at 30 days were low: death 0.25%, MI 7.7%, repeat PCI 1.7%, and stent thrombosis 0.25%. Conclusion Physician decision-making was affected by OCT imaging prior to PCI in 57% and post-PCI in 27% of all cases. ClinicalTrials.gov Identifier NCT01663896, Observational Study of Optical Coherence Tomography (OCT) in Patients Undergoing Fractional Flow Reserve (FFR) and Percutaneous Coronary Intervention (ILUMIEN I).

Original languageEnglish (US)
Pages (from-to)3346-3355
Number of pages10
JournalEuropean heart journal
Volume36
Issue number47
DOIs
StatePublished - Dec 14 2015

Keywords

  • Fractional flow reserve
  • Optical coherence tomography
  • Percutaneous coronary intervention
  • Periprocedural myocardial infarction
  • Stent

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Wijns, W., Shite, J., Jones, M. R., Lee, S. W. L., Price, M. J., Fabbiocchi, F., Barbato, E., Akasaka, T., Bezerra, H., & Holmes, D. (2015). Optical coherence tomography imaging during percutaneous coronary intervention impacts physician decision-making: ILUMIEN i study. European heart journal, 36(47), 3346-3355. https://doi.org/10.1093/eurheartj/ehv367