Author + information
- Sang Yeub Lee, MD, PhD,
- Ron Waksman, MD and
- Hector M. Garcia-Garcia, MD, PhD∗ ()
- ↵∗MedStar Washington Hospital Center, 110 Irving Street, NW, Suite 4B-1, Washington, DC 20010
We have read with great interest the paper by Prati et al. (1) on the CLI-OPLI II study (Centro per la Lotta contro l’Infarto-Optimisation of Percutaneous Coronary Intervention). The newly defined suboptimal stent deployment was associated with an increased risk of major adverse cardiac events. Since the evidence to support the clinical benefit of optical coherence tomography (OCT) during percutaneous coronary intervention (PCI) remains limited, this study provides important information about its use for stent deployment. However, we would like to draw attention to the data presented in the CLI-OPCI II study, especially regarding baseline characteristics and definitions of suboptimal OCT stent deployment.
First, the combination of many conditions obfuscates the interpretation of results. Patients with different clinical presentations (stable ischemic heart disease and an acute coronary syndrome) and different types of stents (i.e., bare-metal stent, drug-eluting stent, and bioabsorbable vascular scaffold) were included. Since in other studies, PCI guidance using imaging has been beneficial mostly in acute coronary syndrome (2) (i.e., ST-segment elevation myocardial infarction), and each device has a different neointimal growth pattern and extent, it is difficult to draw any conclusion from this report.
Second, the parameters for suboptimal stent deployment are too many to be measured and interpreted online in the catheterization laboratory. The authors suggested 6 significant factors that had different weightings. Conversely, in the most recent published IVUS-XPL (Impact of Intravascular Ultrasound Guidance on Outcomes of Xience Prime Stents in Long Lesions) trial, the authors chose only 1 IVUS criterion for stent optimization after PCI (3). This latter simple approach is easier to adopt and implement in clinical practice.
Third, the definition of suboptimal OCT stent deployment has been changed (Table 1), despite the authors’ claim: “The aim of the present study was to assess the impact of these pre-specified OCT quantitative criteria (CLI OPCI I study) on clinical outcomes after PCI” (4). It would be a great contribution to the field if the authors would present an analysis similar to that of the XPL study (considering only 1 criterion, minimal lumen area greater than the lumen area at the distal reference segment) to present a simplified approach that could be easily embraced in clinical practice.
Please note: Dr. Waksman has reported relationships with Biotronik, Medtronic, AstraZeneca, Boston Scientific, Abbott Vascular, The Medicines Company, St. Jude Medical, Biosensors International, and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation
- Prati F.,
- Romagnoli E.,
- Burzotta F.,
- et al.
- Witzenbichler B.,
- Maehara A.,
- Weisz G.,
- et al.
- Prati F.,
- Di Vito L.,
- Biondi-Zoccai G.,
- et al.