Que nos puede aportar el OCT intracoronario
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1 XXXI Jornadas SOLACI. 10ª Región CONOSUR LIIIº Congreso Chileno de Cardiología y Cirugía Cardiovascular Hotel Patagónico. Puerto Varas. Chile (30 Nov 1 Dic 2016) Que nos puede aportar el OCT intracoronario Fernando Alfonso Departamento de Cardiología Hospital Universitario de La Princesa Universidad Autónoma de Madrid Instituto Investigación Sanitaria (IIS-IP) Madrid. ESPAÑA
2 Alfonso F, et al. Minerva Med Dec;103(6): (Figure 1) OCT A B C C D T
3 Gonzalo N, Escaned J, Alfonso F, et al J Am Coll Cardiol 2012;59: Paque Visualization 61 Intermediate Lesions (OCT, IVUS, FFR) FFR <0.80 OCT MLA 1.95 mm2 (AUC 0.74) Sens 82%, Spec 63%
4 Vulnerable Paque Visualization A B? C 52-year-old male. HBP and smoker. Anterior STEMI treated with fibrinolysis (TNK) the day before # DB /04/2009 Alfonso F, et al. Minerva Med Dec;103(6): (Figure 3)
5 Vulnerable Paque Visualization STEMI Ino Y, et al. JACC Cardiovasc Interv. 2011;4:
6 Underlying Pathological Substrate: STEMI vs NSTEMI NSTEMI Ino Y, et al. JACC Cardiovasc Interv. 2011;4:
7 Underlying Pathological Substrate: STEMI vs NSTEMI Alfonso F, Virmani R. JACC Cardiovasc Interv. 2011;4:83-86.
8 Vulnerable Paque Visualization 126 Pts: PR 44%, OCT-erosion 31%, OCT-CN 8%. Representative Case of Probable OCT-Erosion Jia H, et al. J Am Coll Cardiol 2013;62:
9 Vulnerable Paque Visualization Plaque erosion the underlying substrate in 31 STEMI Pts Intact Fibrous Cap (IFC) on OCT Group 1: 40% Pts with subcritically occlusive plaque were treated with dual antiplatelet alone Group 2: 60% Pts underwent stenting All pts asymptomatic at 2 years IFC Prati F, et al. J Am Coll Cardiol Img 2013;6:283 7 SMC & Proteoglycans
10 Vulnerable Paque Visualization 139 consecutive ACS patients 82 PR & 57 IFC FU 32 Mo Niccoli G, et al. Eur Heart J 2015 Jun 7;36(22):
11 Vulnerable Paque Visualization Intact Fibrous Cap Heterogeneous Pathologic Substrate Plaque Erosion Thrombus Healed Rupture Necrotic Core Stable Calcified Plaque Alfonso F, Virmani R. Eur Heart J Jun 7;36(22): The coronary substrate determines prognosis in acute coronary syndromes: the kaleidoscope has been shaken again!
12 Vulnerable Paque Visualization Neoatherosclerosis:The elusive link between very late ISR and ST A B C T E D C B D E Alfonso F, J Am Coll Cardiol 2013;61:155
13 A OCT: Unexpected Causes of ST 49-year-old man with a large anterior myocardial infarction was referred to our centre for rescue angioplasty after failed thrombolysis. SES implanted 6 years before in the LAD. B 30/10/2010
14 OCT: Unexpected Causes of ST A B C D
15 OCT: Unexpected Causes of ST A 49-year-old man with a large anterior myocardial infarction was referred to our centre for rescue angioplasty after failed thrombolysis. SES implanted 6 years before in the LAD. B C 30/10/2010
16 Vulnerable Paque Visualization A B C SB D E F Alfonso F, J Am Coll Cardiol 2013 Dec 10;62(23):2254.
17 Alfonso F, et al. Eurointervention 2015 Aug 22;11(4):e1-2. Vulnerable Paque Visualization Calcified nodule: a double paradox on coronary imaging 75-year-old man, stable effort angina, normal cardiac biomarkers, 10 years after 2 BMS in the RCA
18 Vulnerable Paque Visualization In-Stent Restenosis Caused by a Calcified Nodule: A Novel Pattern of Neoatherosclerosis A B C D Alfonso F, et al. Canadian Journal of Cardiology (2015)
19 Vulnerable Paque Visualization In-Stent Restenosis Caused by a Calcified Nodule: A Novel Pattern of Neoatherosclerosis B C D Alfonso F, et al. Canadian Journal of Cardiology (2015)
20 Alfonso F, et al. Circulation. 2012;126: Spontaneous Coronary Artery Dissection A Intramural Hematoma C
21 CASE 2 OCT A B SB FL FL C D FL FL Alfonso F. Eur Heart J Feb;30(3):385.
22 A CASE 2 OCT B FL C D ST Alfonso F. Eur Heart J Feb;30(3):385.
23 IC Imaging & Actue Stent Complications Imola F...Prati F. EuroIntervention Nov;6(5):575-81
24 IC Imaging & Actue Stent Complications 670 patients were included: in the OCT group and 335 in the Angio group. OCT disclosed adverse features requiring further interventions in 34.7%. Unadjusted analyses showed that the OCT group had a significantly lower one-year risk of cardiac death (1.2% vs. 4.5%, p=0.010), cardiac death or MI (6.6% vs. 13.0%, p=0.006), and the composite of cardiac death, MI, or repeat revascularisation (9.6% vs. 14.8%, p=0.044). Angiographic plus OCT guidance was associated with a significantly lower risk of cardiac death or MI even at extensive multivariable analysis adjusting for baseline and procedural differences between the groups (OR=0.49 [ ], p=0.037) and at propensity-score adjusted analyses. Prati F. EuroInterventio 2012;8:
25 IC Imaging & Actue Stent Complications Suboptimal stent deployment is associated with subacute stent thrombosis: Optical Coherence Tomography insights from a multicenter matched study The CLI-THRO study 21 patients subacute stent thrombosis 42 controls uneventful follow-up - Dissections - Underexpansion - Edge disease - malapposition Prati F, Alfonso F. Am Heart J Feb;169(2):
![5% one-sided CI: [-0.70, - ] P noninferiority = 0.](/docs-images/92/110002086/images/26-4.jpg "001 P superiority = 0.12-0.70 OCT better 0.")
26 ILUMEN III TCT Randomized 158 OCT-guided PCI 146 IVUS-guided PCI 146 angiography-guided PCI 140 Final OCT available for primary endpoint analysis 135 Final OCT available for primary endpoint analysis Primary Endpoint Final post-pci MSA by OCT 140 Final OCT available for primary endpoint analysis OCT 5.79 mm 2 [4.54, 7.34] IVUS 5.89 mm 2 [4.67, 7.80] 97.5% one-sided CI: [-0.70, - ] P noninferiority = P superiority = OCT better 0. 0 IVUS better -1.0mm 2 NI margin OCT: > Expansion vs Angio < Dis & Malapp vs IVUS >70% EEL Ali ZA
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