OCT-Guided Distal Left Main Bifurcation PCI: Mid-Term Outcomes From a Multicenter South-Asian Registry

Optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) enhances treatment of complex coronary artery lesions, including left main (LM) disease, by enabling lesion morphology assessment and stent optimization, thereby reducing major adverse cardiac events (MACE).

The aim of this study was to evaluate the feasibility, safety, and mid-term outcomes of OCT-guided PCI for distal LM bifurcation lesions in the South-Asian population.

This prospective, multicenter, observational registry included 100 consecutive patients (aged 20-80 years) undergoing OCT-guided PCI for distal LM bifurcation lesions. The primary endpoint was procedural success, defined as residual angiographic stenosis of < 30%, thrombolysis in myocardial infarction (TIMI) 3 flow in all major branches, and adequate stent expansion (≥ 80%) in all vessels. Secondary endpoints included MACE, all-cause mortality, myocardial infarction, stent thrombosis, and target vessel revascularization (TVR) at 12 months.

The primary endpoint was attained in 85% of the patients. At the 12-month follow-up, MACE occurred in 1% of patients, including one (1%) cardiac mortality and one (1%) in-hospital definite stent thrombosis. No TVR or stroke was observed. The mean contrast volume used was 190.6 (71.3) mL, with significantly lower usage in the provisional stented group (174.7 mL) compared to the 2-/3-stented group (p < 0.001). The cumulative impact of OCT guidance was observed in 53% of the included patients (preprocedure: 49%, postprocedure: 13%). An extended follow-up of 18 months showed no additional MACE rates.

OCT-guided PCI was found to be safe for distal LM bifurcation lesions with good procedural success and low rates of MACE and stent thrombosis.

Clinical Trials Registry of India: CTRI/2021/07/034819.