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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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When in dark, follow the light: optimal coherence tomography prevents recurrence and guides complex, stent-related lesions
Session:
Posters 4 - Écran 8 - Cardiologia de Intervenção
Speaker:
Patrícia M. Alves
Congress:
CPC 2019
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.1 Invasive Imaging and Functional Assessment
Session Type:
Posters
FP Number:
---
Authors:
Patrícia M. Alves; Ana Vera Marinho; Manuel Oliveira Santos; Luís Candal Leite; Rui Baptista; Elisabete Jorge; João Silva Marques; Vitor Azevedo Matos; Marco Costa; Lino Gonçalves
Abstract
<p>BACKGROUND: Optimal coherence tomography (OCT) provides accurate characterization of plaque lesions and is very sensitive in detecting suboptimal stent implantation. Possibly, OCT parameters can predict fractional flow reserve (FFR). We aimed to characterize the applicability of OCT in plaque characterization and its utility in guiding angioplasty. Additionally, we assessed its correlation to FFR.</p> <p>METHODS: We prospectively included all 80 patients that underwent OCT-guided angioplasty in our centre from November 2014 to October 2018. Clinical, angiographic, OCT and FFR data were collected. The patients were followed up for a median 15 [IQR 7-27] months. Outcomes included all-cause death, acute coronary syndrome (ACS) and heart failure (HF).</p> <p>RESULTS: Mean age was 64±12 years and 74% were male. Indications for angiography were stable angina in 40% cases, ACS in 43%, and ACS associated angioplasty complications in 7%. Around 10% lesions were associated with heart allograft vasculopathy. Left anterior descending (LAD) was involved in 64%, the right coronary (RCA) in 16% and the circumflex (LCx) in 20%. Stent-related lesion was present in 45% (stent re-stenosis in 29%), fibrocalcified plaque in 40%, thrombus in 7% and spontaneous dissection in 7%. Mean minimal luminal area (MLA) was lower for LAD lesions (1.8±0.7 mm vs 2.4±0.7mm in RCA and 2.3±1.1 in LCx, p=0.013 and 0.021). Mean lesion length (LL) did not vary between vessels; it was 4.2±2.5 smaller than mean stent length (19.8±4 vs 24.1±5, p<0.001). Mean reference distal diameter (RDD) did not vary from mean stent diameter (2.9±0.50 vs 2.9±0.45 mm, p=0.07). FFR was performed in 25% cases. MLA had a strong correlation with FFR (r<sup>2</sup> 0.8, p<0.001) (figure 1). A ROC-derived cut-point of 2.2 cm<sup>2</sup> for MLA had a sensitivity of 71% and specificity of 90% for a FFR value of 0.80. Around 39% cases required OCT-guided post-dilation. At 15 months, ACS rate was 7.2%, HF was 8.8% and all-cause mortality was 5.8%. Predictors for ACS included MLA [HR 0.5 (95% CI 0.4-0.9), p=0.021] and OCT-guided post-dilatation [HR 0.4 (95% CI 0.3-0.8), p=0.013], but not LL (p=0.221) or stent diameter (p=0.061) </p> <p>CONCLUSIONS: OCT is very useful in assessing stent-related complications and guiding post-dilation. MLA has a strong correlation with FFR, with high specificity. Both MLA and OCT-guided post-dilation were important predictors of ACS recurrence.</p>
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