{"id":"1756af800fa0","type":"article","url":"https://hartvaat.nl/2024/11/14/ilumien-iv-oct-predictoren-van-klinische-uitkomsten-na-stentimplantatie/","title":"ILUMIEN IV: OCT-predictoren van klinische uitkomsten na stentimplantatie","title_en":"Optical coherence tomography predictors of clinical outcomes after stent implantation: the ILUMIEN IV trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["intracoronaire-beeldvorming"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehae521","source_url":"https://doi.org/10.1093/eurheartj/ehae521","authors":["Ulf Landmesser","Ziad A Ali","Akiko Maehara","Mitsuaki Matsumura","Richard A Shlofmitz","Giulio Guagliumi","Matthew J Price","Jonathan M Hill","Takashi Akasaka","Francesco Prati","Hiram G Bezerra","William Wijns","David Leistner","Paolo Canova","Fernando Alfonso","Franco Fabbiocchi","Giuseppe Calligaris","Rohit M Oemrawsingh","Stephan Achenbach","Carlo Trani","Balbir Singh","Robert J McGreevy","Robert W McNutt","Shih-Wa Ying","Jana Buccola","Gregg W Stone"],"significance":6,"published":"2024-11-14","source_date":"2024-11-14","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/intravasculaire-echografie-ivus-oct/","https://hartvaat.nl/kennis/farmacologie/betablokkers-farmacologie/"],"congress":"","summary_en":"This ILUMIEN IV analysis identified OCT-derived parameters (minimum stent area, dissection, malapposition) that predict clinical outcomes after PCI, informing the criteria for procedural optimization with intravascular imaging.","created":"2026-07-03T10:31:18Z","updated":"2026-07-03T13:30:19Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van ILUMIEN IV identificeerde OCT-kenmerken die klinische uitkomsten na stentimplantatie voorspellen. Minimale stentexpansie en malapositie waren de sterkste risicofactoren, wat optimalisatiedoelen definieert.","abstract_original":"BACKGROUND AND AIMS: Observational registries have suggested that optical coherence tomography (OCT) imaging-derived parameters may predict adverse events after drug-eluting stent (DES) implantation. The present analysis sought to determine the OCT predictors of clinical outcomes from the large-scale ILUMIEN IV trial. METHODS: ILUMIEN IV was a prospective, single-blind trial of 2487 patients with diabetes or high-risk lesions randomized to OCT-guided versus angiography-guided DES implantation. All patients underwent final OCT imaging (blinded in the angiography-guided arm). From more than 20 candidates, the independent OCT predictors of 2-year target lesion failure (TLF; the primary endpoint), cardiac death or target-vessel myocardial infarction (TV-MI), ischaemia-driven target lesion revascularization (ID-TLR), and stent thrombosis were analysed by multivariable Cox proportional hazard regression in single treated lesions. RESULTS: A total of 2128 patients had a single treated lesion with core laboratory-analysed final OCT. The 2-year Kaplan-Meier rates of TLF, cardiac death or TV-MI, ID-TLR, and stent thrombosis were 6.3% (n = 130), 3.3% (n = 68), 4.3% (n = 87), and 0.9% (n = 18), respectively. The independent predictors of 2-year TLF were a smaller minimal stent area (per 1 mm2 increase: hazard ratio 0.76, 95% confidence interval 0.68-0.89, P < .0001) and proximal edge dissection (hazard ratio 1.77, 95% confidence interval 1.20-2.62, P = .004). The independent predictors of cardiac death or TV-MI were smaller minimal stent area and longer stent length; of ID-TLR were smaller intra-stent flow area and proximal edge dissection; and of stent thrombosis was smaller minimal stent expansion. CONCLUSIONS: In the ILUMIEN IV trial, the most important OCT-derived post-DES predictors of both safety and effectiveness outcomes were parameters related to stent area, expansion and flow, proximal edge dissection, and stent length."}