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DOCTORS: OCT-guided PCI associated with better outcomes than standard PCI
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PCI guided by optical coherence tomography was linked with better clinical outcomes vs. standard angiography-guided PCI, according to results of the DOCTORS study presented at the European Society of Cardiology Congress.
In patients with non-ST-segment elevation ACS, OCT “provided useful additional information beyond that obtained by angiography alone, and impacted directly on physician decision-making,” presenter Nicolas Meneveau, MD, PhD, from University Hospital Jean Minjoz, Besançon, France, said in a press release.
Nicolas Meneveau
The researchers analyzed data from 240 patients with NSTEACS who were randomly assigned to undergo PCI guided by standard fluoroscopy alone or fluoroscopy plus OCT.
The primary endpoint was the functional result of PCI as measured by fractional flow reserve (FFR) after implantation of a stent in a culprit lesion.
Other purposes of the study, Meneveau said during a presentation, were to evaluate whether using OCT could provide useful clinical information beyond that which could be determined by angiography, and to assess whether such information modified clinician decision making.
The primary endpoint was significantly better in the OCT group compared with the angiography group (FFR value, 0.94 vs. 0.92, P = .005). The OCT group also had more patients with FFR > 0.9 (82.5% vs. 64.2%; P = .0001).
OCT “led to a change in procedural strategy in half of cases,” Meneveau said in the release.
The groups did not differ significantly in type 4a periprocedural MI (OCT, 33%; angiography, 40%; P = .28) and were identical in the rates of periprocedural complications (5.8%) and acute kidney injury (1.6%), according to the results.
In the cohort, OCT "provided useful additional information beyond that obtained by angiography alone, and impacted directly on physician decision-making," Meneveau said.
For example, before stent implantation, clinicians saw more thrombi (69% vs. 47%; P = .0004) and more calcifications (45.8% vs. 9%; P < .0001) in the OCT group, leading to antiplatelet therapy being used more frequently in the OCT group (53.3% vs. 35.8%).
Stent malapposition was seen in 32% of the OCT group but cannot be seen with fluoroscopy alone. Also, according to the researchers, clinicians could see the following more frequently in the OCT group: stent underexpansion (42% vs. 10.8%), incomplete lesion coverage (20% vs. 17%) and edge dissection (37.5% vs. 4%).
As a result, the researchers determined, post-stent overinflation was more often used in the OCT group (43% vs. 12.5%; P < .0001) and the OCT group had less residual stenosis (7% vs. 8.7%; P = .01). The improved FFR value observed in the OCT group was driven by improved stent expansion, which improved from an average of 78.9±12.4% post PCI to 84.1±7.3% post optimization (p<0.0001 by the paired t test).
The findings “add to the cumulating body of evidence in favor of a potential benefit of OCT to guide angioplasty,” Meneveau said in the release. “The improvement in functional outcomes could translate into a clinical benefit in the longer term.” – by James Clark
References:
Meneveau N, et al. Hot Line: Coronary artery disease and imaging. Presented at: European Society of Cardiology Congress; Aug. 27-31, 2016; Rome.
Meneveau N, et al. Circulation. 2016;doi:10.1161/CIRCULATIONAHA.116.024393.
Disclosure: Meneveau reports receiving consultant fees and speaker honoraria from AstraZeneca, Bayer, Bristol-Myers Squibb/Pfizer, Daiichi Sankyo and St. Jude Medical; and speaker honoraria from Boehringer Ingelheim.