OCT-Guided PCI According to Lesion Length and Vessel Diameter: Post Hoc Analysis of OCCUPI Trial

The clinical impact of optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) based on lesion characteristics remains unclear.

This study aimed to assess the impact of OCT-guided PCI for complex lesions on clinical outcomes according to lesion length and reference vessel diameter (RVD).

In the OCCUPI (Optical Coherence Tomography-guided Coronary Intervention in Patients with Complex Lesions) trial, 1,604 patients with complex lesions were classified according to the median lesion length (32 mm) and RVD (2.8 mm) measured by quantitative coronary angiography. The primary endpoint was the 1-year incidence of major adverse cardiac events, a composite of cardiac death, myocardial infarction, stent thrombosis, or ischemia-driven target vessel revascularization. The median follow-up duration was 365 days (Q1-Q3: 365-365 days).

The OCT guidance group showed a lower incidence of major adverse cardiac events than the angiography guidance group in patients with lesion length ≥32 mm (HR: 0.55; 95% CI: 0.32-0.95; P = 0.031) and RVD <2.8 mm (HR: 0.51; 95% CI: 0.28-0.92; P = 0.026). Across stratified groups based on lesion length and RVD, OCT guidance consistently demonstrated a direction of effect favoring OCT-guided PCI across all lesions (P for interaction = 0.526), with a particularly significant reduction in lesions ≥32 mm with RVD <2.8 mm (HR: 0.46; 95% CI: 0.23-0.94; P = 0.041).

This post hoc analysis of the OCCUPI trial showed that clinical outcomes consistently favored OCT-guided PCI across varying lesion lengths and RVD, with the most pronounced benefit evident in lesions ≥32 mm with RVD <2.8 mm. (Optical CoherenCe Tomography-gUided Coronary Intervention in Patients With Complex lesIons: a Randomized Controlled Trial [OCCUPI Trial]; NCT03625908).