Benefit of coronary stenting using available intracoronary tools in high-risk patients. The OPTI-XIENCE study.

BACKGROUND: The clinical benefit of using ICT for coronary stent optimization remains uncertain in randomized trials, in which a unique ICT was used in most cases. AIM: To assess the clinical impact of intracoronary techniques (ICT) for stent optimization in high-risk patients. METHODS: The OPTI-XIENCE study is a prospective, observational, multicenter international study including high-risk patients undergoing coronary stenting, in whom any ICT was used for stent optimization at the operator's discretion. The control group was the extended-risk cohort of the XIENCE V USA study, in which no ICT was used. The primary endpoint was the 1-year rate of target lesion failure (TLF), defined as a composite of cardiac death, target-vessel myocardial infarction, or ischemia-driven target lesion revascularization. RESULTS: 753 patients were included. The most frequently used ICT was optical coherence tomography (61.4 %), followed by intravascular ultrasound (22.5 %) and pressure wire in 163 (21.6 %). After propensity score matching with the XIENCE V USA cohort (n = 3179), 653 matched pairs were analyzed. The incidence of TLF at 1 year was significantly lower in the OPTI-XIENCE (3.4 % vs. 9.3 %, p < 0.001), driven by a reduction in target-vessel myocardial infarction (0.9 % vs. 5.6 %, p < 0.001) and ischemia-driven target lesion revascularization (1.1 % vs. 4.6 %, p < 0.001). The incidence of probable or definitive stent thrombosis at 1 year was 0.3 % vs 0.9 %, respectively (p = 0.154). CONCLUSION: The use of any ICT for stent optimization in high-risk PCI significantly improves clinical outcomes compared to angiographic guidance alone. These findings support an individualized use of ICT to optimize complex PCI outcomes.

Duke Scholars

Author Mitchell Wolfe Krucoff Medicine, Cardiology