The study aims to assess contemporary practice in OCT use during routine interven-tional practice and to assess the impact of the MLD-MAX algorithm on real-world PCI in a large unselected European all-comer-study cohort.
Angiography is the current standard method to guide PCI strategy in clinical practice. However, angiography has a number of well-described limitations, primarily through only providing an assessment of luminal dimensions without delineation of the burden of atheroma-tous disease. Angiography also provides suboptimal assessment of post PCI complications such as stent underexpansion or malapposi-tion, residual dissections or thrombus, and tissue prolapse. These limi-tations may be overcome in part by intravascular imaging (IVI), which allows tomographic, cross-sectional imaging of the vessel wall. Meta-analyses of randomized and registry studies of IVI-guided vs. angi-ography-guided PCI have suggested that IVI-guidance may improve clinical outcome following PCI. Optical coherence tomography (OCT) provides high-resolution (10-20 μm) cross-sectional images of plaque microarchitecture, stent place-ment and size and strut coverage. Recently the MLD-MAX algorithm was developed to guide and stand-ardize coronary stent implantation based on sizing of the vessel at the proximal and distal reference using the EEL.
Study Type
OBSERVATIONAL
Enrollment
2,000
No intervention planned; study is observational
Universitätsklinikum Frankfurt - Med. Klinik 3 - Kardiologie
Frankfurt am Main, Germany
RECRUITINGStent expansion: number of participants with optimal / acceptable / unacceptable stent expansion
Stent expansion is defined by the MSA achieved in the proximal and distal stented segments relative to their respective reference lumen areas. Stent expansion will be categorised as follows: Optimal stent expansion (y/n); acceptable stent expansion (y/n); unacceptable stent expansion (y/n); post-PCI stent expansion (%).
Time frame: At baseline
Minimal Stent Area (MSA)
Imaging Outcome: minimal stent area as continuous measure; Final Post-PCI MSA (per target lesion basis) assessed by final-OCT after PCI; measured at an independent OCT core laboratory. Imaging-Outcome: Minimal-Stent-Area (MSA), continuous measure
Time frame: At baseline
Mean stent expansion
The mean stent area (stent volume/analyzed stent length) divided by the average of proximal and distal reference lumen areas x 100
Time frame: At baseline
Intra-stent plaque protrusion and thrombus: number of major and minor protusion area / stent area
Defined as a mass attached to the luminal surface or floating within the lumen, meeting the following criteria: Protrusion/thrombus is defined as any intraluminal mass protruding at least 0.2 mm within the luminal edge of a stent strut, and will be further classified as Major and Minor: * Major: Protrusion area/Stent area at site of tissue protrusion ≥10% and the minimal intra-stent flow area (MSA - protrusion area) is unacceptable (\<90% of respective proximal or distal reference area * Minor: Protrusion area/Stent area at site of tissue protrusion is \<10%, or is ≥10% but the minimal intraluminal flow area (MSA - protrusion area) is acceptable (≥90% of respective proximal or distal reference area
Time frame: At baseline
Number of participants with untreated reference segmant disease
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Defined as focal disease with untreated MLA \<4.5 mm2 within 5 mm from the proximal and/or distal stent edges. Sub-classified by the amount of untreated lipid plaque, divided into 3 grades: Low (≤90° of lipid arc), Medium (\>90°-\<180° of lipid arc) and High (≥180° of lipid arc).
Time frame: At baseline
Number of participants with major and minor edge dissections
Edge dissections will be tabulated as: * Major (%): ≥60 degrees of the circumference of the vessel at site of dissection and ≥3 mm in length * Minor (%): any visible edge dissection \<60 degrees of the cir-cumference of the vessel or \<3 mm in length
Time frame: At baseline
Number of participants with major and minor stent malapposition
Defined as frequency (%) of incompletely apposed stent struts (defined as stent struts clearly separated from the vessel wall (lumen bor-der/plaque surface) without any tissue behind the struts with a distance from the adjacent intima of ≥0.2 mm and not associated with any side branch). Malapposition will be further classified as: * Major: if associated with unacceptable stent expansion (as de-fined above) * Minor: if associated with acceptable stent expansion (as defined above) Stent Malapposition will be tabulated as: Major (%); Minor (%); All (Major and Minor) (%)
Time frame: At baseline
Number of participants with procedural complications
Defined as prolonged ST-segment elevation or depression (\>30 minutes), cardiac arrest or need for defibrillation or cardioversion or hypotension/heart failure requiring mechanical or intravenous hemody-namic support or intubation or procedural death
Time frame: At baseline
Number of participants with adverse events
Target lesion failure (TLF; cardiac death, TV-MI or ischemia-driven target lesion revascularization)
Time frame: At 30 days follow-up
Number of participants with adverse events
Target lesion failure (TLF; cardiac death, TV-MI or ischemia-driven target lesion revascularization)
Time frame: At 6 months follow-up