Clinical impact and lesion characteristics of suboptimal optical coherence tomography stent deployment in patients with acute myocardial infarction

Background Suboptimal stent implantation parameters identified by optical coherence tomography (OCT) were associated with worse outcomes in patients with coronary artery disease. Clinical consequences of suboptimal OCT stent implantation parameters and the association between lesion characteristics and suboptimal OCT stent deployment in acute myocardial infarction (AMI) patients undergoing drug-eluting stents (DES) remain unclear. Purpose This study aimed to demonstrate the impact of OCT-identified stent structures on long term outcomes, and found the association between lesion characteristics at baseline and suboptimal OCT parameters after DES implantation in AMI patients. Methods Between January 2018 and December 2020, AMI patients who underwent DES and post-procedural OCT imaging at the target lesions were selected. The endpoint was a composite of device-oriented cardiovascular events (DoCE), including cardiac death, target-vessel related myocardial infarction, and clinically driven target-lesion revascularization. Patients were followed at least 3 years. Suboptimal OCT stent deployment was defined as the presence of ≥1 of the OCT findings significantly associated with DoCE. In a subgroup with pre-procedural OCT imaging for target lesions, lesion morphology was assessed. Results A total of 906 lesions with final OCT imaging in 881 patients were assessed in the study. At a median follow-up of 4.0 (quartiles 3.0-4.1) years, minimum stent area <4.5 mm² (HR 2.41, P = 0.002), irregular protrusion (HR 2.13, P = 0.008), and distal reference lumen narrowing (HR 4.77, P < 0.001) were independent predictors of device failure. Patients with suboptimal OCT stent deployment had a higher incidence of DoCE (HR 2.71, P < 0.001), which was primarily driven by cardiac death (HR 2.51, P = 0.025) and target lesion revascularization (HR 3.66, P = 0.002). In the subgroup analysis for pre-procedural lesion characteristics, multivariate analysis identified plaque rupture, cholesterol crystals, and smaller reference lumen area as predictors of suboptimal OCT stent deployment (vs optimal OCT stent deployment). Conclusions Suboptimal stent deployment, defined by specific quantitative OCT criteria, was associated with device failure at long-term follow-up in AMI patients treated with DES. Specific OCT-identified lesion characteristics were associated with suboptimal OCT stent deployment.