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Guiding Intervention for Complex Coronary Lesions by Optical Coherence Tomography or Intravascular Ultrasound
Do-Yoon Kang1, Jung-Min Ahn1, Sung-Cheol Yun2
1Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Journal of the American College of Cardiology
|October 25, 2023
Summary
Optical coherence tomography (OCT) and intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI) showed similar effectiveness for complex lesions. OCT-guided PCI had fewer procedural complications, suggesting improved safety in challenging cases.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Optical coherence tomography (OCT) and intravascular ultrasound (IVUS) are imaging modalities used to guide percutaneous coronary intervention (PCI).
- While both have demonstrated comparable outcomes in general PCI, their comparative effectiveness in complex coronary artery lesions is not well-established.
Purpose of the Study:
- To compare the effectiveness and safety of OCT-guided versus IVUS-guided PCI specifically in patients with complex coronary artery lesions.
- To analyze a subgroup of patients from the OCTIVUS trial focusing on challenging lesion types.
Main Methods:
- A prespecified subgroup analysis of the OCTIVUS trial was conducted.
- Included complex coronary artery lesions: unprotected left main disease, bifurcation disease, aorto-ostial lesions, chronic total occlusions, severely calcified lesions, in-stent restenosis, diffuse long lesions, or multivessel PCI.
- The primary endpoint was a composite of cardiac death, target vessel myocardial infarction, or ischemia-driven target vessel revascularization.
Main Results:
- In 1,475 patients with complex lesions (719 OCT-guided, 756 IVUS-guided), the primary endpoint occurred in 6.5% of the OCT group and 7.4% of the IVUS group (HR: 0.87; P=0.50) at 2-year follow-up.
- No significant difference was observed in the incidence of contrast-induced nephropathy (1.9% vs 1.5%; P=0.46).
- Major procedural complications were significantly lower in the OCT-guided group (1.7%) compared to the IVUS-guided group (3.4%; P=0.03).
Conclusions:
- OCT-guided PCI demonstrated similar effectiveness to IVUS-guided PCI for the primary composite endpoint in patients with complex coronary artery lesions.
- OCT-guided PCI was associated with a significantly lower incidence of major procedural complications.
- These findings suggest OCT may offer a safety advantage in guiding PCI for complex coronary anatomies.
Keywords:
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