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 ―
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.
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BibTeX
@article{usui2026determinants,
title = {{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 ―}},
author = {Eisuke Usui and Tsunekazu Kakuta and Yoshihisa Kanaji and Masahiro Hada and Tatsuhiro Nagamine and Hiroki Ueno and Kai Nogami and Kodai Sayama and Kohei Wakabayashi and Taishi Yonetsu and Takuya Mizukami and Myong Hwa Yamamoto and Sakiko Yasuhara and Koki Shishido and Shigeru Saito and Nobuaki Kobayashi and Masamichi Takano and Yosuke Oishi and Seita Kondo and Tenjin Nishikura and Yoshiyasu Minami and Junya Ako and Toshitaka Okabe and Masahiko Ochiai and Toru Naganuma and Satoru Mitomo and Sunao Nakamura and Takumi Higuma and Junya Shite and Amane Kozuki and Satoru Suwa and Teruyoshi Kume and Shiro Uemura and Genki Naruse and Hiroyuki Okura and Masao Yamaguchi and Hiroyuki Fujii and Shigeki Kimura and Masamichi Iwasaki and Tomoyo Sugiyama and Mamoru Nanasato and Tomotaka Dohi and Takashi Ashikaga and Hiromasa Otake and Toshiro Shinke and on behalf of the ATLAS-OCT Investigators},
journal = {Circulation Journal},
year = {2026},
month = oct,
doi = {10.1253/circj.cj-26-0431},
url = {https://www.jstage.jst.go.jp/article/circj/advpub/0/advpub_CJ-26-0431/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - 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 ―
AU - Eisuke Usui
AU - Tsunekazu Kakuta
AU - Yoshihisa Kanaji
AU - Masahiro Hada
AU - Tatsuhiro Nagamine
AU - Hiroki Ueno
AU - Kai Nogami
AU - Kodai Sayama
AU - Kohei Wakabayashi
AU - Taishi Yonetsu
AU - Takuya Mizukami
AU - Myong Hwa Yamamoto
AU - Sakiko Yasuhara
AU - Koki Shishido
AU - Shigeru Saito
AU - Nobuaki Kobayashi
AU - Masamichi Takano
AU - Yosuke Oishi
AU - Seita Kondo
AU - Tenjin Nishikura
AU - Yoshiyasu Minami
AU - Junya Ako
AU - Toshitaka Okabe
AU - Masahiko Ochiai
AU - Toru Naganuma
AU - Satoru Mitomo
AU - Sunao Nakamura
AU - Takumi Higuma
AU - Junya Shite
AU - Amane Kozuki
AU - Satoru Suwa
AU - Teruyoshi Kume
AU - Shiro Uemura
AU - Genki Naruse
AU - Hiroyuki Okura
AU - Masao Yamaguchi
AU - Hiroyuki Fujii
AU - Shigeki Kimura
AU - Masamichi Iwasaki
AU - Tomoyo Sugiyama
AU - Mamoru Nanasato
AU - Tomotaka Dohi
AU - Takashi Ashikaga
AU - Hiromasa Otake
AU - Toshiro Shinke
AU - on behalf of the ATLAS-OCT Investigators
PY - 2026
DA - 2026/10/21
JO - Circulation Journal
DO - 10.1253/circj.cj-26-0431
UR - https://www.jstage.jst.go.jp/article/circj/advpub/0/advpub_CJ-26-0431/_article
AB - 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.
SN - 1347-4820
SN - 1346-9843
ER -