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OCT May Detect Procedural Issues Undetected by Angiography
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Results from an observational study found that optical coherence tomography can improve clinical outcomes for patients undergoing PCI.
Researchers compared angiographic guidance alone vs. matched patients who underwent angiographic guidance plus OCT for PCI within 30 days at three high OCT-volume centers in Italy from 2009 to 2011.
In all, 670 patients were matched 1:1 with the use of OCT determined by senior staff members with established skills and caseloads. Results showed that OCT found adverse features requiring further interventions in 34.7% of cases. Further stenting was needed in 12.6% of cases, in 5.4% to treat an edge dissection and in 7.2% to enlarge a reference lumen area that was less than 4 mm2. Additional balloon dilatation was needed in 22.1% of cases, in 14% to fix stent underexpansion and in 8.1% to reduce intrastent thrombus.
At 1 year, patients in the OCT group had a significantly lower rate of cardiac death (1.2% vs. 4.5%; P=.01) and the study’s primary endpoint of cardiac death or MI (6.6% vs. 13%; P=.006). These patients also had a lower risk for a composite outcome of cardiac death, MI or repeat revascularization (9.6% vs. 14.8%; P=.044).
Perspective
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Gary S. Mintz, MD
Although registries such as these are always open to criticism, this is the first study to indicate that OCT-guided stent implantation is superior to angiography-guided stent implantation. The results are quite similar to studies comparing IVUS-guidance to angiography-guidance, indicating that it might not be the specific imaging technology that is important, but the additional information provided by intravascular imaging in general.
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