OCT guidance during stent implantation in primary PCI: A randomized multicenter study with nine months of optical coherence tomography follow-up

• Published in: International journal of cardiology 2018-01, Vol.250, p.98-103
• Main Authors: Kala, Petr, Cervinka, Pavel, Jakl, Martin, Kanovsky, Jan, Kupec, Andrej, Spacek, Radim, Kvasnak, Martin, Poloczek, Martin, Cervinkova, Michaela, Bezerra, Hiram, Valenta, Zdenek, Attizzani, Guilherme F., Schnell, Audrey, Hong, Lu, Costa, Marco A.
• Format: Article
• Language: English
• Subjects: Aged; Drug-Eluting Stents; Female; Follow-Up Studies; Humans; Male; Middle Aged; Monitoring, Intraoperative - methods; OCT; Optical coherence tomography; Percutaneous Coronary Intervention - methods; Primary PCI; ST Elevation Myocardial Infarction - diagnostic imaging; ST Elevation Myocardial Infarction - surgery; ST-segment elevation myocardial infarction; Time Factors; Tomography, Optical Coherence - methods
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2017.10.059

To assess the possible merits of optical coherence tomography (OCT) guidance in primary percutaneous coronary intervention (pPCI). 201 patients with ST-elevation myocardial infarction (STEMI) were enrolled in this study. Patients were randomized either to pPCI alone (angio-guided group, n=96) or to pPCI with OCT guidance (OCT-guided group, n=105) and also either to biolimus A9 or to everolimus-eluting stent implantation. All patients were scheduled for nine months of follow-up angiography and OCT study. OCT guidance led to post-pPCI optimization in 29% of cases (59% malapposition and 41% dissections). No complications were found related to the OCT study. OCT analysis at nine months showed significantly less in-segment area of stenosis (6% [−11, 19] versus 18% [3, 33]; p=0.0002) in favor of the OCT-guided group. The rate major adverse cardiovascular events were comparable at nine months in both groups (3% in the OCT group versus 2% in the angio-guided group; p=0.87). This study demonstrates the safety of OCT guidance during pPCI. The use of OCT optimized stent deployment in 1/3 of patients in this clinical scenario and significantly reduced in-segment area of stenosis at nine months of follow-up. Whether such improvements in OCT endpoints will have a positive impact on late clinical outcomes, they demand both a larger and longer-term follow-up study.