Determinants and Clinical Impact of Direct Stenting in Optical Coherence Tomography-Guided Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction ― An ATLAS-OCT Substudy ―
Year: 2026
Type: article
Abstract: BACKGROUND: Direct stenting (DS) is a simplified strategy for primary percutaneous coronary intervention (PCI); however, its role in the era of advanced intravascular imaging remains incompletely defined. We aimed to identify determinants of DS use and its impact on procedural efficiency and optical coherence tomography (OCT)-defined stent implantation quality in ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS: The ATLAS-OCT trial was a prospective multicenter nationwide study mandating OCT guidance in Japan. In this subanalysis, clinical characteristics, angiographic and OCT findings, procedural metrics, and clinical outcomes were compared between patients undergoing DS and those treated with balloon predilatation. Among 436 patients, DS was performed in 32.1% (n=140), with marked interinstitutional variability (0-68.3%; P<0.01), suggesting a strong influence of operator preference. DS use was not associated with angiographic features or OCT-defined culprit plaque morphology. DS significantly reduced contrast volume and procedure time. Post-PCI OCT showed a trend towards a larger minimum stent area and greater stent expansion index with DS. These benefits were not associated with in-hospital or 1-year outcomes. CONCLUSIONS: In contemporary OCT-guided primary PCI for STEMI, DS appears to be driven primarily by operator preference rather than lesion characteristics. In this study, DS was associated with improved procedural efficiency without significantly compromising OCT-assessed stent implantation quality or mid-term clinical safety.
Source: Circulation Journal
Authors: Eisuke Usui, Tsunekazu Kakuta, Yoshihisa Kanaji, Masahiro Hada, Tatsuhiro Nagamine, Hiroki Ueno, Kai Nogami, Kodai Sayama, Kohei Wakabayashi, Taishi Yonetsu, Takuya Mizukami, Myong Hwa Yamamoto, Sakiko Yasuhara, Koki Shishido, Shigeru Saito, Nobuaki Kobayashi, Masamichi Takano, Yosuke Oishi, Seita Kondo, Tenjin Nishikura, Yoshiyasu Minami, Junya Ako, Toshitaka Okabe, Masahiko Ochiai, Toru Naganuma, Satoru Mitomo, Sunao Nakamura, Takumi Higuma, Junya Shite, Amane Kozuki, Satoru Suwa, Teruyoshi Kume, Shiro Uemura, Genki Naruse, Hiroyuki Okura, Masao Yamaguchi, Hiroyuki Fujii, Shigeki Kimura, Masamichi Iwasaki, Tomoyo Sugiyama, Mamoru Nanasato, Tomotaka Dohi, Takashi Ashikaga, Hiromasa Otake, Toshiro Shinke, on behalf of the ATLAS-OCT Investigators
Institutions: Tsuchiura Kyodo General Hospital, SHOWA Medical University Koto Toyosu Hospital, Institute of Science Tokyo, SHOWA Medical University, Shonan Kamakura General Hospital, Chiba Hokusou Hospital, Nippon Medical School, Kitasato University, SHOWA Medical University Northern Yokohama Hospital, New Tokyo Hospital, Kawasaki Saiwai Hospital, Kawasaki Municipal Tama Hospital, Saiseikai Nakatsu Hospital, Juntendo University Shizuoka Hospital, Kawasaki Medical School, Gifu University, Yokohama Minami Kyosai Hospital, Mita Hospital, Hyogo Prefectural Awaji Medical Center, Sakakibara Hospital, Juntendo University, Musashino Red Cross Hospital, Kobe University
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7223039666