The real clinical impact of Optical Coherence Tomography (OCT) – defined abnormalities remains unknown. We investigated prognostic impact of tissue protrusion between stent struts after stent implantation in patients with non-ST elevation acute coronary syndromes (NSTEACS).

Prospective study of consecutive NSTEACS pts (≤72h) undergoing PCI for an infarct-related artery presenting a single lesion without diffuse disease on the culprit artery. Pts were treated at the operator’s discretion. OCT was performed after initial coronary angiogram and at end of angioplasty procedure. Prolapse was defined as projection of tissue (plaque/thrombus) into the lumen between stent struts after implantation. Primary endpoint of procedural complications associated no reflow + PCI-related myocardial infarction (MI) (20% rise in troponin over baseline at 24h). Secondary endpoint was functional result of angioplasty assessed by fractional flow reserve (FFR) measured at end of procedure.

43 pts were included, mean age 63±11 ans, 90% men. Tissue protrusion was observed in 35(81%), tissue took up a median 8.85% [IQR 6.2-14.2%] of intra-luminal area over a median length of 2.8mm [IQR 1.4-5.2]. Presence of protrusion was not associated with cardiovascular risk factors or pre-treatment with aspirin, thienopyridines, antiGP IIb/IIIa or anticoagulants. Tissue protrusion had no impact on procedural complications or FFR (Table).

Tissue protrusion through struts after stent implantation is frequent on OCT in NSTEACS pts undergoing angioplasty. It occludes on average 10% of in-stent area but does not limit flow or impact on post-procedural complications.

Abstract 0441 – Table1st quartile [0-6.2%]2nd quartile [6.21-8.85%]3rd quartile [8.86-14.15%]4th quartile [14.16-31%]1st quartile [0-6.2%]No reflow7.7%22.2%025%0.33Peri-procedural MI6 (46%)8 (80%)6 (60%)5 (50%)0.39FFR post-stenting0.94±0.030.94±0.060.93±0.030.93±0.040.99