Impact of intracoronary optical coherence tomography in routine clinical practice: A contemporary cohort study

• Published in: Cardiovascular revascularization medicine 2022-05, Vol.38, p.96-103
• Main Authors: Häner, Jonas D, Duband, Benjamin, Ueki, Yasushi, Otsuka, Tatsuhiko, Combaret, Nicolas, Siontis, George C.M, Bär, Sarah, Stortecky, Stefan, Motreff, Pascal, Losdat, Sylvain, Windecker, Stephan, Souteyrand, Géraud, Räber, Lorenz
• Format: Article
• Language: English
• Subjects: Acute coronary syndrome; Cardiovascular; Cohort Studies; Coronary Angiography - methods; Coronary artery disease; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - pathology; Coronary Artery Disease - therapy; Coronary Vessels - diagnostic imaging; Coronary Vessels - pathology; Humans; Life Sciences; OCT-guided PCI; Optical coherence tomography; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - methods; Retrospective Studies; Stent failure assessment; Stents; Tomography, Optical Coherence - methods; Treatment Outcome
• ISSN: 1553-8389; 1878-0938
• DOI: 10.1016/j.carrev.2021.07.024

AbstractBackground/purposeGuidelines recommend intracoronary optical coherence tomography (OCT) to assess stent failure and guide percutaneous coronary intervention (PCI) but OCT may be useful for other indications in routine clinical practice. Methods/materialsWe conducted an international registry of OCT cases at two large tertiary care centers to assess clinical indications and the potential impact on decision making of OCT in clinical routine. Clinical indications, OCT findings, and their impact on interventional or medical treatment strategy were retrospectively assessed. ResultsOCT was performed in 810 coronary angiography cases (1928 OCT-pullbacks). OCT was used for diagnostic purposes in 67% ( N = 542) and OCT-guided percutaneous coronary intervention in 50% ( N = 404, 136 cases with prior diagnostic indication). Most frequent indications for diagnostic OCT were culprit lesion identification in suspected ACS (29%) and stent failure assessment (28%). OCT findings in the diagnostic setting influenced patient management in 74%. OCT-guided PCIs concerned ACS patients in 45%. Among the 55% with chronic coronary syndrome, long lesions >28 mm (19%), left main PCI (16%), and bifurcation PCI with side-branch-stenting (5%) were the leading indications for PCI-guidance. Post-procedural OCT findings led to corrective measures in 52% (26% malapposition, 14% underexpansion, 6% edge dissection, 3% intrastent mass, 3% geographic plaque miss). ConclusionsOCT was most frequently performed to identify culprit lesions in suspected ACS, for stent failure assessment, and PCI-guidance. OCT may impact subsequent treatment strategies in two out of three patients.