Background:The mismatch between in-stent minimum lumen area (sMLA) and reference vessel lumen area, defined as stent underexpansion (SU), could be an important determinant of stent failure. We tested the clinical predictive value of absolute sMLA in comparison to relative SU in the context of the CLI-OPCI (Centro Per La Lotta Contro L’Infarto-Optimisation of Percutaneous Coronary Intervention) project registry.Methods:We retrospectively analyzed end procedural optical coherence tomography findings in 1211 patients (1422 lesions) undergoing percutaneous coronary intervention, assessing the prevalence and magnitude of residual SU and exploring correlation with outcome in comparison with sMLA.Results:In our series, both sMLA and SU were related to vessel size and anatomic lesion complexity. When compared with patients without adverse event at follow-up, those experiencing device-oriented cardiovascular events (composite of cardiac death, target vessel myocardial infarction, target lesion revascularization, and stent thrombosis) showed a lower sMLA (5.6±2.1 versus 6.1±2.1 mm²; P=0.011) but a comparable degree of SU (11.6±14.1% versus 11.2±13.3%; P=0.734). The prespecified cutoff value of sMLA <4.5 mm², documented in 23.8% of cases, was confirmed as independent outcome predictor for device-oriented cardiovascular events (hazard ratio [HR], 2.05 [95% CI, 1.5–2.9]) including target lesion revascularization (HR, 2.43 [95% CI, 1.7–3.5]) and stent thrombosis (HR, 3.23 [95% CI, 1.7–6.3]). A residual SU of 10%, 20%, and 30% was observed in 38.0%, 18.2%, and 7.6% of cases, respectively. No grade of residual SU significantly increased the risk of stent failure, unless if an SU >20% was associated with an sMLA <4.5 mm² (HR, 3.11 [95% CI, 1.7–5.6]). Finally, an association between stent overexpansion (ie, >110%) and device-oriented cardiovascular events was also observed (HR, 1.60 [95% CI, 1.1–2.3]).Conclusions:Final absolute sMLA and not relative SU was associated with an increased risk of stent failure. A variable grade of SU was common, but it resulted in being clinically relevant only when associated with an sMLA <4.5 mm².

中文翻译：

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基于光学相干断层扫描的最佳支架扩张标准的定义：支架内最小管腔面积与残余支架扩张不足

背景：支架内最小管腔面积 (sMLA) 与参考血管管腔面积之间的不匹配，即支架欠扩张 (SU)，可能是支架失效的重要决定因素。我们在 CLI-OPCI（Centro Per La Lotta Contro L'Infarto-Optimisation of Percutaneous Coronary Intervention）项目注册的背景下测试了绝对 sMLA 与相对 SU 的临床预测值。方法：我们回顾性分析了最终程序光学相干性接受经皮冠状动脉介入治疗的 1211 名患者（1422 个病灶）的断层扫描结果，评估残余 SU 的患病率和程度，并与 sMLA 比较探索与结果的相关性。结果：在我们的系列中，sMLA 和 SU 都与血管大小和解剖病变有关复杂。² ; P = 0.011）但 SU 的程度相当（11.6±14.1% 对 11.2±13.3%；P = 0.734）。sMLA <4.5 mm ²的预设临界值（记录在 23.8% 的病例中）被确认为设备导向心血管事件的独立结果预测因子（风险比 [HR]，2.05 [95% CI，1.5-2.9]），包括目标病变血运重建（HR，2.43 [95% CI，1.7-3.5]）和支架血栓形成（HR，3.23 [95% CI，1.7-6.3]）。在 38.0%、18.2% 和 7.6% 的病例中分别观察到 10%、20% 和 30% 的残余 SU。除非 SU >20% 与 sMLA <4.5 mm 相关²（HR，3.11 [95% CI，1.7–5.6]）。最后，还观察到支架过度扩张（即 >110%）与设备相关的心血管事件之间存在关联（HR，1.60 [95% CI，1.1-2.3]）。结论：最终绝对 sMLA 而不是相对 SU 与支架失效的风险增加。不同等级的 SU 很常见，但只有与 sMLA <4.5 mm ²相关时才具有临床相关性。