Introduction
Methods
Number of delegates/centre (N = 21) | Participating hospital |
---|---|
1 | Amsterdam Medical Centre, Amsterdam |
3 | Amphia Hospital, Breda |
1 | Albert Schweitzer Hospital, Dordrecht |
2 | Erasmus Medical Centre, Rotterdam |
1 | Leiden University Medical Centre, Leiden |
1 | MC Haaglanden, the Hague |
2 | Northwest Clinics; Alkmaar |
3 | Radboud University Medical Centre, Nijmegen |
3 | St Antonius Hospital, Nieuwegein |
2 | University Medical Centre Groningen, Groningen |
1 | University Medical Centre Utrecht, Utrecht |
1 | VU University Medical Centre, Amsterdam |
1 | Clinical presentation |
2 | Risk factors and comorbidities |
3 | Cardiac history |
4 | Non-invasive tests results to evaluate the presence and severity of myocardial ischaemia; electrocardiography, laboratory and non-invasive ischaemia detection |
5 | Formal coronary angiography reports |
6 | Invasive testing such as intravascular ultrasound and fractional flow reserve |
Appropriate use criteria
1 | Operators performing percutaneous revascularisation have appropriate clinical training, experience and have satisfactory outcomes as assessed by quality assurance monitoring |
2 | Revascularisation is performed according to international established standards of care [5] |
3 | The rating panel should rate the appropriateness of the use of OCT on the basis of the clinical scenario presented, including the observed coronary disease, independently of a judgment about the appropriateness of the coronary angiogram within the given scenario |
4 | There are no other significant coronary artery stenoses present apart from those described in the clinical scenario |
5 | Significant coronary stenosis in the clinical scenarios is defined as ≥70% luminal diameter narrowing on angiography or intermediate angiographic luminal narrowing (40–70%), with an abnormal FFR |
6 | FFR ≤0.80 is abnormal and is consistent with downstream ischemia |
7 | Clinical stent strut malapposition is defined as ≥1–2 mm distance between the stent strut and the intimal surface in more than 5% of the total surface area of the stent |
Statistics
Results
Case | Indication (corresponding appendix) | Appropriate use rating | SD |
---|---|---|---|
Identification of culprit lesion in acute coronary syndrome (Fig. 1) | |||
1 | Identification culprit lesion in NSTEMI with angiographic two significant stenosis and no decisive answer on which one is the culprit | M (6) | ±1.37 |
2 | Identification mechanism STEMI (spasm vs. plaque rupture) after thrombectomy followed by severe spasm | M (5) | ±2.41 |
3 | Identification culprit lesion in NSTEMI with abnormal ECG and angiographically no evident thrombus or occlusion | A (7) | ±1.77 |
4 | Identification plaque erosion | A (7) | ±2.02 |
5 | Identification culprit lesion in OHCA with angiographic signs (haziness) | A (7) | ±2.36 |
6 | Identification culprit lesion in MI with abnormal ECG and angiographically intermediate stenosis | M (5) | ±1.88 |
Evaluation of stent thrombosis (supplemental Appendix Fig. 2) | |||
7 | Identification of stent thrombosis mechanism in a STEMI patient | A (8) | ±0.68 |
8 | Re-evaluation with OCT after STEMI of a hazy non-culprit lesion which was initially treated conservatively | M (6) | ±1.94 |
9 | Evaluation of mechanism in recurrent STEMI due to stent thrombosis in proximal LAD | A (9) | ±0.69 |
Evaluation of strut coverage (supplemental Appendix Fig. 3) | |||
10 | Evaluation of strut coverage 4 weeks after initial stent placement in a patient with high bleeding risk (discontinuing DAPT) | M (4) | ±2.51 |
11 | Evaluation of strut coverage 12 weeks after initial stent placement in a patient with high bleeding risk who requires surgery (discontinuing DAPT) | R (3) | ±1.98 |
12 | Evaluation of BVS after ~1.5 years for discontinuing DAPT | M (4) | ±2.76 |
OCT-guided PCI in critical lesions (supplemental Appendix Fig. 4) | |||
13 | Guiding in complicated PCI with unknown apposition/position of the stent in the LMCA and post PCI with possible stent fracture after overexpansion | A (8) | ±1.26 |
14 | Guiding in PCI with bifurcation lesion for sizing and stent strategy | M (5) | ±2.21 |
15 | Guiding in PCI to determine landing zone stent and stent length in angiographically diffuse long lesion | M (6) | ±2.00 |
16 | OCT next to significant FFR for evaluation stenosis severity | R (2) | ±1.83 |
17 | OCT next to non-significant FFR for evaluation stenosis severity | R (3) | ±1.74 |
OCT guidance in PCI in LMCA (supplemental Appendix Fig. 5) | |||
18 | OCT guidance in PCI of the proximal LMCA | R (3) | ±1.46 |
19 | OCT guidance in PCI of the distal LMCA | A (7) | ±1.66 |
Evaluation of stent apposition (supplemental Appendix Fig. 6) | |||
20 | Evaluating thrombosis mechanism in extensive stent thrombosis | A (9) | ±1.03 |
21 | Evaluating stent apposition post PCI in non-complex lesion | M (4) | ±2.39 |
22 | Evaluating severe calcified lesion for treatment strategy (rotablator?) | R (3) | ±1.56 |
23 | Evaluating stent apposition after rotablator treatment in complex diffuse long lesion and placement of multiple stents | A (7) | ±1.85 |
24 | Evaluating stent apposition after extensive post-dilatation in an initially undersized stent | A (7) | ±2.22 |
Identification of unexplained angiographic abnormalities (supplemental Appendix Fig. 7) | |||
25 | Unravel the mechanism for distal occlusion in coronary artery without proximal lesion (local problem or emboli with other origin?) | A (7) | ±2.48 |
26 | Control OCT 5 days after initial angiography in NSTEMI patient which was treated conservatively | A (7) | ±1.39 |
27 | Evaluation haziness (thrombus) in proximal LAD in STEMI patient with incurable cancer (local problem or emboli?) | A (7) | ±2.17 |
28 | Discrepancy between angiographic finding (intermediate stenosis) and FFR (borderline significant) | M (6) | ±2.28 |
29 | Evaluation angiographic haziness in transient STEMI | A (7) | ±1.60 |
Identification of dissection (supplemental Appendix Fig. 8) | |||
30 | Confirmation of SCAD in young patient without classical risk factors for atherosclerotic coronary artery disease | M (6) | ±2.09 |
31 | Identification thrombosis mechanism after thrombosuction resulting in a normal angiography in a patient with a mechanical valve | A (7) | ±2.16 |
32 | Confirmation of SCAD in young patient with classic risk factors for atherosclerotic coronary disease | M (6) | ±2.24 |
Stent sizing (supplemental Appendix Fig. 9) | |||
33 | Sizing for covered stent with risk on blocking substantial side branch | A (7) | ±2.55 |
34 | Sizing for stent in hazy angiography with multiple complex lesions | M (6) | ±1.80 |
35 | Stent sizing in bifurcation lesion (pre PCI) | M (6) | ±1.94 |
Evaluation of stent apposition in critical lesions (supplemental Appendix Fig. 10) | |||
36 | Control OCT after 2 weeks to evaluate stent apposition in proximal LAD with suspected malapposition during initial angiography | A (6.5) | ±2.22 |
37 | Control OCT for stent apposition in a patient with high bleeding risk and angiographically suspected under-expansion | M (6) | ±1.97 |
38 | Evaluating stent apposition in bifurcation lesion (post PCI) | A (7) | ±1.53 |
39 | Identification of the mechanism behind a distal occlusion in a coronary vessel with multiple mild plaques proximally (local or emboli of other origin?) | A (7) | ±1.35 |
40 | Evaluating stent apposition in a patient with high bleeding risk with the intention to keep the duration of DAPT treatment as short as possible | A (7) | ±1.81 |
41 | Routine use of OCT for evaluation stent apposition in PCI of proximal LAD | M (4) | ±1.88 |
In-stent restenosis (supplemental Appendix Fig. 11) | |||
42 | OCT identification of the mechanism of ISR in order to guide therapy, i. e. DES vs. DEB after 1st restenosis | M (6) | ±1.64 |
43 | OCT identification of the mechanism of ISR in order to guide therapy, i. e. DES vs. DEB after 2nd restenosis | A (7) | ±2.35 |
44 | OCT identification of the mechanism of ISR in order to guide therapy, i. e. DES vs. DEB after 3rd restenosis | A (7) | ±1.58 |
Implantation dedicated stent (supplemental Appendix Fig. 12) | |||
45 | Evaluation of stent apposition in a BVS | A (8) | ±2.10 |
46 | Evaluation of stent apposition in a self-expandable stent | A (7) | ±2.16 |
OCT in grafts (supplemental Appendix Fig. 13) | |||
47 | Detection of early cardiac allograft vasculopathy after heart transplant | M (4) | ±2.45 |
48 | Detection of stenosis of a CABG anastomosis | R (3) | ±1.87 |
OCT in CTO (supplemental Appendix Fig. 14) | |||
49 | Evaluation of multiple dissection-like images outside the stent in the sub-intimal path of a previous CTO during follow-up angiography after CTO recanalisation | A (7) | ±2.48 |