Percutaneous Coronary Intervention Guided by Optical Coherence Tomography or Intravascular Ultrasound for True Bifurcation Lesions

BACKGROUND: Imaging-guided percutaneous coronary intervention (PCI) using optical coherence tomography (OCT) or intravascular ultrasound (IVUS) is superior to angiography-guided PCI in true coronary artery bifurcation lesions, yet their comparative effectiveness remains uncertain. OBJECTIVES: The authors sought to compare the effectiveness and safety of OCT-guided vs IVUS-guided PCI in treating true bifurcation lesions. METHODS: The authors conducted a prespecified subgroup analysis of the OCTIVUS (Optical Coherence Tomography Versus Intravascular Ultrasound-Guided Percutaneous Coronary Intervention) trial, which compared OCT- and IVUS-guided PCI in all-comer patients. True bifurcation lesions were identified by coronary angiography. The primary outcome was target-vessel failure, a composite of cardiac death, target-vessel myocardial infarction, or ischemia-driven target-vessel revascularization. Crude and adjusted analyses were performed using inverse probability of treatment weighting and overlap propensity-score weighting. RESULTS: Of the 2,008 patients in the OCTIVUS trial, 428 (21.3%) underwent imaging-guided PCI for true bifurcation lesions; among them, 185 (43.2%) received OCT-guided PCI and 243 (56.8%) received IVUS-guided PCI. During the follow-up period (median, 2.0 years; IQR: 1.1-2.9), the primary outcome occurred in 20 of 185 patients (11.3%, 2-year Kaplan-Meier estimates; 95% CI: 6.2%-16.2%) in the OCT-guided group vs 18 of 243 patients (8.4%; 95% CI: 4.4%-12.2%) in the IVUS-guided group (HR: 1.27; 95% CI: 0.70-2.44; P = 0.40). These findings remained consistent in adjusted analyses using inverse probability of treatment weighting (HR: 1.12; 95% CI: 0.57-2.22; P = 0.74) and overlap propensity-score weighting (HR: 1.15; 95% CI: 0.16-2.24; P = 0.69). CONCLUSIONS: In patients with true bifurcation lesions, OCT-guided PCI demonstrated a similar risk of target-vessel failure compared with IVUS-guided PCI. (Optical Coherence Tomography versus Intravascular Ultrasound-Guided Percutaneous Coronary Intervention; NCT03394079).