PCI guided by OCT and IVUS have Similar Outcomes in Complex Coronary Lesions

Patients undergoing percutaneous coronary intervention (PCI) for complex coronary lesions had similar outcomes whether they were guided by optical coherence tomography (OCT) or intravascular ultrasound (IVUS), according to a prespecified analysis of the OCTIVUS trial.

The rate of target vessel failure did not significantly differ between the two imaging methods. While there were fewer major procedural complications and target vessel-related myocardial infarctions (MIs) when OCT was used, the overall results indicate that "either OCT or IVUS can be used safely and efficiently with equally good acute and long-term results in the vast majority of complex PCI procedures," the authors wrote in the Journal of the American College of Cardiology.

Dr. Ziad Ali, lead discussant of the study, highlighted that this data provides operators with flexibility in choosing their preferred imaging modality for complex patients, without a substantial difference in outcomes. The study, known as OCTIVUS, focused on patients with complex coronary lesions. Previous research has indicated the benefits of intravascular imaging guidance in PCI, with both OCT and IVUS showing positive outcomes. However, it was unclear if one of these methods had an advantage in complex cases.

The analysis included 1,475 patients who had complex coronary lesions, which included a variety of conditions like unprotected left main disease, bifurcation disease, chronic total occlusions, and more. The results demonstrated no significant difference in the rate of target vessel failure between the two imaging methods.

The prespecified analysis of the OCTIVUS trial included 1,475 patients who had complex coronary lesions, and the following results were obtained:

• Target Vessel Failure Rates: The primary outcome, the rate of target vessel failure, was not significantly different between the groups guided by optical coherence tomography (OCT) and intravascular ultrasound (IVUS). The target vessel failure occurred in 6.5% of patients in the OCT-guided group and 7.4% of patients in the IVUS-guided group.
• Lesion Characteristics: Lesion characteristics between the OCT and IVUS groups were generally similar, with a slightly lower proportion of left main disease in the OCT group. In the OCT-guided group, procedures used a greater amount of contrast dye but were shorter in duration.
  
• Stent Optimization: After PCI, intravascular ultrasound (IVUS) was associated with a higher percentage of lesions that met all stent optimization criteria (46.0% in the IVUS group vs. 37.6% in the OCT group).
  
• Procedural Complications: Major procedural complications requiring intervention were less frequent in the OCT group (1.7%) compared to the IVUS group (3.4%), with a statistically significant difference (P = 0.03).
  
• Secondary Endpoints: Most secondary endpoints occurred at similar rates in both groups. However, target vessel-related myocardial infarction (MI) was less common in the OCT group (0.8%) compared to the IVUS group (2.4%), with a statistically significant difference (P = 0.03).
  
• Median Follow-Up: Over a median follow-up of 2 years, the lack of difference in target vessel failure between the OCT and IVUS groups remained consistent in adjusted analyses.
  
• Subgroup Analysis: Subgroup analyses by lesion type generally showed similar results as in the overall analysis. Notably, in patients treated for in-stent restenosis, OCT guidance was associated with a significantly lower rate of target vessel failure compared with IVUS guidance (10.5% vs. 29.5%), with a hazard ratio of 0.36.
  

This study offers important insights for interventional cardiologists, indicating that OCT and IVUS can be chosen based on operator preference without a substantial impact on clinical outcomes. The decision may depend on the specific characteristics of the lesions being treated, with some leaning towards OCT for certain cases like in-stent restenosis or routine PCI, and IVUS for more complex lesions.

Reference:

Kang, D.-Y., Ahn, J.-M., Yun, S.-C., Hur, S.-H., Cho, Y.-K., Lee, C. H., Hong, S. J., Lim, S., Kim, S.-W., Won, H., Oh, J.-H., Choe, J. C., Hong, Y. J., Yoon, Y.-H., Kim, H., Choi, Y., Lee, J., Yoon, Y. W., Kim, S.-J., … Park, D.-W. Guiding intervention for complex coronary lesions by optical coherence tomography or intravascular ultrasound. Journal of the American College of Cardiology,2023. https://doi.org/10.1016/j.jacc.2023.10.017