PMID- 26242713
DCOM- 20160919
LR  - 20161215
IS  - 1522-9645 (Electronic)
IS  - 0195-668X (Linking)
VI  - 36
IP  - 47
DP  - 2015 Dec 14
TI  - Optical coherence tomography imaging during percutaneous coronary intervention
      impacts physician decision-making: ILUMIEN I study.
PG  - 3346-55
LID - 10.1093/eurheartj/ehv367 [doi]
AB  - 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).
CI  - (c) The Author 2015. Published by Oxford University Press on behalf of the
      European Society of Cardiology.
FAU - Wijns, William
AU  - Wijns W
AD  - Cardiovascular Research Center, OLV Hospital, Moorselbaan 164, Aalst B 9300,
FAU - Shite, Junya
AU  - Shite J
AD  - Osaka Saiseikai Nakatsu Hospital, Osaka, Japan.
FAU - Jones, Michael R
AU  - Jones MR
AD  - Baptist Health Lexington, Lexington, KY, USA.
FAU - Lee, Stephen W L
AU  - Lee SW
AD  - University of Hong Kong, Queen Mary Hospital, Hospital Authority, Pok Fu Lam,
      Hong Kong.
FAU - Price, Matthew J
AU  - Price MJ
AD  - Scripps Clinic, La Jolla, CA, USA.
FAU - Fabbiocchi, Franco
AU  - Fabbiocchi F
AD  - Centro Cardiologico Monzino, IRCCS, Milan, Italy.
FAU - Barbato, Emanuele
AU  - Barbato E
AD  - Cardiovascular Research Center, OLV Hospital, Moorselbaan 164, Aalst B 9300,
FAU - Akasaka, Takashi
AU  - Akasaka T
AD  - Wakayama Medical University, Wakayama, Japan.
FAU - Bezerra, Hiram
AU  - Bezerra H
AD  - University Hospitals Case Medical Center, Harrington Heart and Vascular
      Institute, Cleveland, OH, USA.
FAU - Holmes, David
AU  - Holmes D
AD  - Mayo Clinic, Rochester, MN, USA.
LA  - eng
SI  -
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20150804
PL  - England
TA  - Eur Heart J
JT  - European heart journal
JID - 8006263
SB  - IM
CIN - Eur Heart J. 2015 Dec 14;36(47):3356-8. PMID: 26351394
MH  - Angina Pectoris/etiology
MH  - Clinical Decision-Making
MH  - Coronary Angiography/methods
MH  - Coronary Stenosis/diagnosis/physiopathology/*surgery
MH  - Female
MH  - Fractional Flow Reserve, Myocardial/physiology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Percutaneous Coronary Intervention/*methods
MH  - Practice Patterns, Physicians'
MH  - Prospective Studies
MH  - Stents
MH  - Tomography, Optical Coherence/methods
PMC - PMC4677272
OT  - Fractional flow reserve
OT  - Optical coherence tomography
OT  - Percutaneous coronary intervention
OT  - Periprocedural myocardial infarction
OT  - Stent
EDAT- 2015/08/06 06:00
MHDA- 2016/09/20 06:00
CRDT- 2015/08/06 06:00
PHST- 2015/04/13 00:00 [received]
PHST- 2015/07/15 00:00 [accepted]
PHST- 2015/08/06 06:00 [entrez]
PHST- 2015/08/06 06:00 [pubmed]
PHST- 2016/09/20 06:00 [medline]
AID - ehv367 [pii]
AID - 10.1093/eurheartj/ehv367 [doi]
PST - ppublish
SO  - Eur Heart J. 2015 Dec 14;36(47):3346-55. doi: 10.1093/eurheartj/ehv367. Epub 2015
      Aug 4.