Optical Coherence Tomography versus Intravascular Ultrasound-Guided Primary Percutaneous Coronary Intervention in...

Area of Science:

• Cardiology
• Medical Imaging
• Interventional Cardiology

Background:

• Current guidelines recommend intravascular imaging for percutaneous coronary intervention (PCI).
• Optical coherence tomography (OCT) and intravascular ultrasound (IVUS) are endorsed imaging modalities.
• Comparative data for OCT versus IVUS in ST-elevation myocardial infarction (STEMI) are limited.

Purpose of the Study:

• To compare clinical outcomes between OCT-guided and IVUS-guided primary PCI in STEMI patients.
• To evaluate the safety and efficacy of OCT versus IVUS in a real-world STEMI population.

Main Methods:

• A multicenter registry analysis of 2,291 STEMI patients undergoing primary PCI.
• Patients were stratified into OCT-guided (n=244) and IVUS-guided (n=2,047) groups.
• Propensity score matching was used to adjust for baseline differences, followed by Kaplan-Meier analysis and hazard ratio calculation.

Main Results:

• After propensity matching (187 pairs), target vessel-related major adverse cardiac events (TV-MACE) rates were similar (8.6% vs 10.2%, p=0.723) over a median 722-day follow-up.
• No significant differences were found in TV-MACE, cardiovascular death, or target vessel revascularization between the groups.
• OCT guidance was associated with more procedures without stenting (12.8% vs 5.3%) and fewer stents per patient (0.99 vs 1.15).

Conclusions:

• OCT-guided PCI demonstrated comparable clinical outcomes to IVUS-guided PCI in STEMI patients.
• Both OCT and IVUS are effective imaging modalities for guiding primary PCI in STEMI.
• The choice between OCT and IVUS may depend on procedural characteristics and operator preference.