Suboptimal stent deployment defined by specific quantitative OCT criteria—minimum stent area <4.5 mm², irregular protrusion, and distal reference lumen narrowing—was associated with device failure at long-term follow-up in patients with acute MI successfully treated with drug-eluting stents.
Key Findings
Results
Minimum stent area <4.5 mm², irregular protrusion, and distal reference lumen narrowing were independent predictors of device-oriented cardiovascular events in acute MI patients receiving drug-eluting stents.
Study included 881 patients with 906 lesions undergoing postprocedural OCT imaging after successful drug-eluting stent implantation for acute MI.
Patients were enrolled between January 2018 and December 2020 at the target institution.
Median follow-up was 4.0 years.
The primary endpoint was device-oriented cardiovascular events (DOCE), a composite of cardiac death, target-vessel related MI, and target-lesion revascularization.
These three OCT findings were identified as independent predictors via multivariate analysis.
Results
Patients with suboptimal OCT stent deployment had a higher incidence of device-oriented cardiovascular events compared to those with optimal deployment.
Suboptimal OCT stent deployment was defined as the presence of ≥1 OCT findings significantly associated with DOCE.
The increased incidence of DOCE was primarily driven by cardiac death and target-lesion revascularization.
Target-vessel related MI was also a component of the composite endpoint but was a lesser driver.
The association persisted over a median follow-up of 4.0 years.
Results
Plaque rupture, cholesterol crystals, and smaller reference lumen area were independent predictors of suboptimal OCT stent deployment in the preprocedural OCT subgroup.
A subgroup of 789 lesions had preprocedural OCT imaging available for lesion morphology assessment.
These three lesion characteristics were identified as independent predictors via multivariate analysis.
Plaque rupture and cholesterol crystals are morphological features detectable by OCT prior to intervention.
Smaller reference lumen area is a quantitative measure also assessed on preprocedural OCT.
Methods
The study defined suboptimal stent deployment using a composite OCT criterion requiring the presence of at least one of the three identified adverse OCT findings.
The three defining criteria were: minimum stent area <4.5 mm², irregular protrusion, and distal reference lumen narrowing.
Each of these findings was significantly associated with DOCE in the analysis before being incorporated into the composite definition.
This definition was derived from the study's own outcomes analysis rather than applied a priori.
Postprocedural OCT imaging was performed at target lesions in all 906 lesions included in the main analysis.
Methods
The study population consisted exclusively of acute MI patients, representing a high-risk cohort in whom OCT-guided stent optimization may have particular clinical relevance.
Patients had acute myocardial infarction (both STEMI and NSTEMI presentations are implied by the term 'acute MI').
All patients received drug-eluting stents and had successful intervention confirmed before inclusion.
Postprocedural OCT imaging was required for inclusion, limiting the cohort to centers with OCT capability.
Enrollment spanned January 2018 to December 2020, representing contemporary practice.
What This Means
This research suggests that after a heart attack, the quality of stent placement—as measured by a high-resolution imaging technique called optical coherence tomography (OCT)—has a significant impact on long-term outcomes. Specifically, stents that were too small (minimum stent area less than 4.5 mm²), had irregular tissue protrusion into the stent, or were placed near a segment where the artery narrows were associated with a higher risk of serious cardiac events including cardiac death and the need for repeat procedures over roughly four years of follow-up. The study followed 881 patients across 906 treated artery sites to reach these conclusions.
The research also found that certain features of the artery blockage itself—visible on OCT imaging taken before the procedure—can predict when stent placement is likely to be suboptimal. Specifically, plaque rupture (a break in the fatty deposit causing the blockage), cholesterol crystals within the plaque, and a naturally smaller artery diameter were all associated with a greater chance of ending up with a suboptimal stent result. This finding is important because it suggests that operators who identify these features before stenting could anticipate and potentially plan around greater technical challenges.
This research matters because it provides specific, quantitative OCT-based criteria that clinicians can use to evaluate stent placement quality immediately after the procedure in heart attack patients. Rather than relying on general visual assessment, having defined thresholds—like a minimum stent area cutoff—gives interventional cardiologists a clearer standard to work toward. The study also highlights that certain plaque characteristics increase the difficulty of achieving optimal stent deployment, which could inform decisions about additional interventional techniques in high-risk lesions.
Zhao J, Zhao R, Chen Y, Cui L, Ma X, Lin T, et al.. (2026). Clinical Impact and Lesion Characteristics of Suboptimal Optical Coherence Tomography Stent Deployment in Patients With Acute Myocardial Infarction.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.125.045609