Feasibility of optical coherence tomography-guided primary percutaneous coronary intervention for STEMI: all-comer...

Intravascular imaging for acute coronary syndrome is recommended in the guidelines; however, the actual rate of patients with ST-segment elevation myocardial infarction (STEMI) who successfully undergo optical coherence tomography (OCT)-guided primary percutaneous coronary intervention (PCI) is unclear. This study aimed to determine the feasibility of OCT-guided primary PCI and identify the patient population that would benefit most from OCT guidance in STEMI. The ATLAS-OCT trial was a prospective, single-arm, all-comers study conducted at 16 institutions. The primary endpoint was the feasibility of OCT guidance for primary PCI, defined as successful image acquisition (vessel's circumferential or > 270° visualization along > 70% of the lesion's length, as evaluated by an independent core laboratory). A total of 632 patients (mean age: 68.4 years; 80.2% male) were enrolled in the study. OCT-guided PCI was performed in 503 patients, whereas OCT guidance was avoided in 129 patients for patient's condition. Successful image acquisition was achieved in all but seven patients who underwent OCT. The primary endpoint was achieved in 78.5% (496/632) of patients. No procedural complications were associated with OCT. Patients with left main disease (adjusted odds ratio, 4.1; 95% confidence interval, 1.2-14.7; p = 0.024), estimated glomerular filtration rate (mL/min/1.73 m²) < 30 (3.7; 1.6-8.3; p = 0.002), and Killip IV (2.5; 1.3-4.6; p = 0.003) were significantly avoided for OCT guidance. OCT guidance was feasible in four-fifths of all-comers with STEMI. Further studies are warranted to evaluate the efficacy of OCT-guided PCI in selected patient populations based on the findings of this trial (UMIN000048590).