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OCT or Angiography Guidance for PCI in Complex Bifurcation Lesions
Niels R Holm1, Lene N Andreasen1, Omeed Neghabat1
1From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.).
Optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) significantly reduced major adverse cardiac events in complex coronary artery bifurcation lesions compared to standard angiography guidance over two years.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Percutaneous coronary intervention (PCI) guided by imaging, specifically optical coherence tomography (OCT), may offer improved outcomes over traditional angiography.
- The benefit of routine OCT guidance for complex coronary artery bifurcation lesions remains uncertain compared to angiography-guided PCI.
Purpose of the Study:
- To evaluate whether routine OCT guidance in PCI for complex coronary artery bifurcation lesions improves clinical outcomes compared to angiography-guided PCI.
Main Methods:
- A multicenter, randomized, open-label trial involving 1201 patients across 38 European centers.
- Patients with complex bifurcation lesions were randomized 1:1 to either OCT-guided PCI or angiography-guided PCI.
- The primary endpoint was a composite of major adverse cardiac events (MACE) at a median 2-year follow-up.
Main Results:
- At 2 years, 59 patients (10.1%) in the OCT-guided PCI group experienced MACE versus 83 patients (14.1%) in the angiography-guided PCI group (HR, 0.70; 95% CI, 0.50-0.98; P=0.035).
- No significant difference in procedure-related complications was observed between the groups.
- A substantial proportion of patients in both groups had complex lesions involving the left main coronary artery.
Conclusions:
- OCT-guided PCI is associated with a lower incidence of MACE at 2 years in patients with complex coronary artery bifurcation lesions compared to angiography-guided PCI.
- Routine OCT guidance demonstrates a potential benefit in managing complex coronary artery bifurcation lesions.
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