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Optical Coherence Tomography-Guided versus Angiography-Guided PCI.

Ziad A Ali1, Ulf Landmesser1, Akiko Maehara1

  • 1From St. Francis Hospital, Roslyn (Z.A.A., R.A.S.), Clinical Trials Center, Cardiovascular Research Foundation, New York (Z.A.A., A.M., M.M.), the Center for Interventional Cardiovascular Care, Columbia University (A.M., O.D.), and the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), New York, and New York Institute of Technology, Glen Head (Z.A.A.) - all in New York; the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charité-Universitätsmedizin Berlin (U.L., D.L.), Berlin Institute of Health (U.L.), and Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Partner Site Berlin (U.L.), Berlin, and the Department of Medicine, Cardiology, Goethe University Hospital, and DZHK Partner Site Rhein-Main, Frankfurt (D.L.) - all in Germany; IRCCS Galeazzi Sant'Ambrogio Hospital (G.G.) and IRCCS Centro Cardiologico Monzino (F.F.), Milan, Saint Camillus International University of Health Sciences and Centro per la Lotta contro l'Infarto, Rome (F.P.), and Ospedale Papa Giovanni XXIII, Bergamo (P.C.) - all in Italy; the Division of Cardiovascular Diseases, Scripps Clinic, La Jolla (M.J.P.), and Abbott Vascular, Santa Clara (R.J.M., R.W.M., H.N., J.B., N.E.J.W.) - both in California; Royal Brompton Hospital, London (J.M.H.); Wakayama Medical University, Wakayama, Japan (T.A.); Tampa General Hospital, Tampa, FL (H.G.B.); the Lambe Institute for Translational Medicine and Cúram, University of Galway, Galway, Ireland (W.W.); and the Department of Cardiology, Hospital Universitario de la Princesa, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid (F.A.).

The New England Journal of Medicine
|August 27, 2023
PubMed
Summary

Optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) improved minimum stent area compared to angiography guidance. However, no significant difference in target-vessel failure rates was observed between the two PCI methods at two years.

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Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Medical Imaging

Background:

  • Clinical outcomes data comparing optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) with traditional angiography-guided PCI remain limited.
  • Understanding the comparative efficacy and safety of these imaging modalities is crucial for optimizing PCI procedures.

Purpose of the Study:

  • To prospectively evaluate the impact of OCT-guided PCI versus angiography-guided PCI on key clinical outcomes.
  • To compare the minimum stent area and the incidence of target-vessel failure at two years between the two procedural guidance methods.

Main Methods:

  • A prospective, randomized, single-blind trial involving 2487 patients with diabetes or complex coronary lesions.
  • Patients were assigned to either OCT-guided PCI or angiography-guided PCI, with a final blinded OCT assessment in the angiography group.
  • Primary efficacy endpoints included minimum stent area and a composite of target-vessel failure at 2 years.

Main Results:

  • OCT-guided PCI resulted in a significantly larger minimum stent area (5.72 mm² vs. 5.36 mm², P<0.001).
  • Target-vessel failure occurred in 7.4% of the OCT group and 8.2% of the angiography group (Hazard Ratio, 0.90; P=0.45).
  • Stent thrombosis was lower in the OCT group (0.5% vs. 1.4%).

Conclusions:

  • OCT guidance leads to improved stent expansion compared to angiography guidance during PCI.
  • No significant difference in the rate of target-vessel failure at two years was detected between OCT-guided and angiography-guided PCI.
  • Further research may explore the long-term implications and specific patient subgroups that benefit most from OCT guidance.