OCT guided PCI had less stent thrombosis compared to angiography-guided PCI

Medical researchers have delved into a groundbreaking study comparing the outcomes of percutaneous coronary intervention (PCI) guided by optical coherence tomography (OCT) versus angiography. This rigorous investigation aimed to shed light on the potential advantages of OCT in optimizing PCI procedures, as well as its impact on clinical outcomes.

The findings, published in a recent issue of The New England Journal Of Medicine by Zaid A. Ali and colleagues revealed that OCT guided PCI was more successful and had less stent thrombosis compared to angiography-guided PCI.

The study was meticulously designed as a prospective, randomized, single-blind trial to explore the efficacy and safety of using OCT-guided PCI as compared to the traditional angiography-guided approach. The participants were individuals with medication-treated diabetes or complex coronary-artery lesions. These subjects were randomly allocated to either the OCT-guided PCI group or the angiography-guided PCI group. A key feature of the trial was that a final blinded OCT procedure was conducted for patients in the angiography group, ensuring a comprehensive comparison.

The trial was executed across 80 medical centers spanning 18 countries, involving a substantial cohort of 2487 patients. Of these, 1233 patients underwent OCT-guided PCI, while 1254 patients were subjected to angiography-guided PCI. The study focused on two primary efficacy endpoints: the minimum stent area after PCI, assessed via OCT, and target-vessel failure at the 2-year mark. Target-vessel failure was defined as a composite of cardiac death, target-vessel myocardial infarction, or ischemia-driven target-vessel revascularization.

● The results revealed intriguing insights. The minimum stent area after PCI was notably larger in the OCT-guided group, measuring 5.72±2.04 mm², compared to the angiography-guided group, which recorded 5.36±1.87 mm².

● This difference, with a mean value of 0.36 mm², was statistically significant (95% confidence interval [CI], 0.21 to 0.51; P<0.001). In terms of target-vessel failure at the 2-year mark, the study reported occurrences in 7.4% of patients in the OCT group and 8.2% in the angiography group.

● The hazard ratio for this comparison was 0.90 (95% CI, 0.67 to 1.19; P=0.45), indicating no significant between-group difference.

● Safety assessment was a pivotal aspect of the study. OCT-related adverse events were minimal, with only 1 patient in the OCT group and 2 patients in the angiography group encountering such events.

● Stent thrombosis within 2 years was observed in 0.5% of patients in the OCT group and 1.4% in the angiography group, reaffirming the general safety of the OCT-guided PCI approach.

The study's conclusions reflect the nuanced nature of its findings. While the OCT-guided approach led to a larger minimum stent area post PCI, the difference did not translate into a significant variation in the percentage of patients experiencing target-vessel failure at the 2-year mark. This outcome underscores the complexity of clinical interventions and highlights the multifactorial nature of patient outcomes.

In summary, the study offers a comprehensive comparison between OCT-guided and angiography-guided PCI, shedding light on their respective advantages and limitations. While the former resulted in a larger stent area, it did not lead to a substantial improvement in the occurrence of target-vessel failure. These insights contribute to the ongoing refinement of coronary interventions, emphasizing the importance of evidence-based medical decisions and individualized patient care.

Reference:

Ali, Z. A., Landmesser, U., Maehara, A., Matsumura, M., Shlofmitz, R. A., Guagliumi, G., Price, M. J., Hill, J. M., Akasaka, T., Prati, F., Bezerra, H. G., Wijns, W., Leistner, D., Canova, P., Alfonso, F., Fabbiocchi, F., Dogan, O., McGreevy, R. J., McNutt, R. W., … Stone, G. W. (2023). Optical coherence tomography–guided versus angiography-guided PCI. The New England Journal of Medicine. https://doi.org/10.1056/nejmoa2305861