Clinical Impact of Irregular Protrusion Angle After Coronary Stenting at Culprit Lesions With ST-Elevation Myocardial Infarction　― An Intravascular Optical Coherence Tomography Study ―

Q: What are the key findings of this study?

Large irregular protrusion (maximum angle ≥180°) after coronary stenting in STEMI patients increased the 1-year risk of device-oriented clinical events compared to small irregular protrusion.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: ST-elevation myocardial infarction (STEMI) (n=139). Intervention: Large irregular protrusion (maximum IP angle ≥180°) vs. Small irregular protrusion (0° < angle < 180°). Primary outcome: Composite of cardiac death, target vessel myocardial infarction, target lesion revascularization, and stent thrombosis at 1 year (OR 5.86, 95% CI 1.25-27.52, p=0.009).

Q: What does this research mean for the field?

Large irregular protrusion (maximum angle ≥180°) after coronary stenting in STEMI patients significantly increases the 1-year risk of device-oriented clinical events compared to small irregular protrusion. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Atsushi Kyodo; Tsunenari Soeda; Akihiko Okamura; Saki Iwai; Azusa Sakagami; Kazutaka Nogi; Daisuke Kamon; Yukihiro Hashimoto; Tomoya Ueda; Makoto Watanabe; Yoshihiko Saito

doi:10.1253/circrep.cr-21-0071

July 8, 2021Circulation ReportsOpen Access

Clinical Impact of Irregular Protrusion Angle After Coronary Stenting at Culprit Lesions With ST-Elevation Myocardial Infarction　― An Intravascular Optical Coherence Tomography Study ―

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Key result

Large irregular protrusion after STEMI stenting linked to ~486% higher device-oriented event risk versus small protrusions.

OR 5.86
95% CI 1.25-27.52
P=0.009
n=139

Figures

Why the study?

Irregular protrusion after stenting predicts worse 1-year cardiovascular events, but its clinical impact at STEMI culprit lesions needed evaluation.

Does large irregular protrusion (maximum IP angle ≥180°) after coronary stenting increase the risk of composite cardiovascular events in STEMI patients?

Study Design

Type

Observational (n=139)

Multicenter

No

Structured PICO

Does large irregular protrusion (maximum IP angle ≥180°) after coronary stenting increase the risk of composite cardiovascular events in STEMI patients?

P

Population

139 consecutive ST-elevation myocardial infarction (STEMI) patients with optical coherence tomography (OCT)-detected irregular protrusion (IP) after stenting, treated with OCT-guided PCI at a single center in Japan.

I

Intervention

Large irregular protrusion (maximum IP angle ≥180°) detected by OCT after coronary stenting

C

Comparator

Small irregular protrusion (0° < maximum IP angle < 180°) detected by OCT after coronary stenting

O

Outcome

Composite of cardiac death, target vessel myocardial infarction, target lesion revascularization, and stent thrombosis at 1 year after the index percutaneous coronary intervention (PCI)composite

Main Result

Effect estimate: OR 5.86 (95% CI 1.25-27.52)

Absolute Event Rate: 12.5% vs 1.5%

p-value: p=0.009

A maximum irregular protrusion angle ≥180° detected by OCT after coronary stenting in STEMI patients is associated with a significantly higher risk of 1-year cardiovascular events.

Limitations

Retrospective study conducted at a single center with a limited number of patients
Potential selection bias as treatment strategy and OCT procedure were performed at the discretion of each interventionist
Novel classification of IP without investigation of correlation with histopathological findings
Inability to completely discriminate thrombus from irregular protrusion
Methods to reduce irregular protrusion volume remain unknown
Retrospective in nature and conducted at a single center with a limited number of patients
Treatment strategy and OCT procedure were performed at the discretion of each interventionist, leading to potential selection bias
Challenging to discriminate thrombus from protruding tissue using OCT
Methods to reduce IP volume remain unknown

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Implication

Large irregular protrusion after STEMI stenting signals higher event risk; leaves open whether OCT-guided optimization improves outcomes.

Abstract

Background:A recent optical coherence tomography (OCT) registry showed that the presence of irregular protrusion (IP) after coronary stenting was a predictor of worse 1-year cardiovascular events. This study evaluated the clinical impact of OCT-detected IP after coronary stenting at ST-elevation myocardial infarction (STEMI) culprit lesions.

Discussion

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Cite This Study

Kyodo et al. (2021) conducted an observational in ST-elevation myocardial infarction (STEMI) (n=139). Large irregular protrusion (maximum IP angle ≥180°) vs. Small irregular protrusion (0° < angle < 180°) was evaluated on Composite of cardiac death, target vessel myocardial infarction, target lesion revascularization, and stent thrombosis at 1 year (OR 5.86, 95% CI 1.25-27.52, p=0.009). Large irregular protrusion (maximum angle ≥180°) after coronary stenting in STEMI patients increased the 1-year risk of device-oriented clinical events compared to small irregular protrusion.

synapsesocial.com/papers/6a1804408008e5848e6f50b5 https://doi.org/10.1253/circrep.cr-21-0071

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Clinical Impact of Irregular Protrusion Angle After Coronary Stenting at Culprit Lesions With ST-Elevation Myocardial Infarction　― An Intravascular Optical Coherence Tomography Study ―

Figures

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Clinical Impact of Irregular Protrusion Angle After Coronary Stenting at Culprit Lesions With ST-Elevation Myocardial Infarction　― An Intravascular Optical Coherence Tomography Study ―

Figures

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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Clinical Impact of Irregular Protrusion Angle After Coronary Stenting at Culprit Lesions With ST-Elevation Myocardial Infarction ― An Intravascular Optical Coherence Tomography Study ―

Figures

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Clinical Impact of Irregular Protrusion Angle After Coronary Stenting at Culprit Lesions With ST-Elevation Myocardial Infarction ― An Intravascular Optical Coherence Tomography Study ―

Figures

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading

Clinical Impact of Irregular Protrusion Angle After Coronary Stenting at Culprit Lesions With ST-Elevation Myocardial Infarction　― An Intravascular Optical Coherence Tomography Study ―

Clinical Impact of Irregular Protrusion Angle After Coronary Stenting at Culprit Lesions With ST-Elevation Myocardial Infarction　― An Intravascular Optical Coherence Tomography Study ―