Optical coherence tomography versus angiography to guide percutaneous coronary intervention in patients with in-stent restenosis: an observational study

BACKGROUND: Although optical coherence tomography (OCT) guidance with the 'MLDMAX' criteria is very useful for de-novo lesions during percutaneous coronary intervention (PCI), there are limited studies on its benefits in patients with in-stent restenosis (ISR). This study aimed to compare the clinical outcomes of patients with ISR who underwent repeat PCI (re-PCI) with OCT or angiographic guidance. METHODS: This retrospective study enrolled 2142 patients with ISR who underwent re-PCI at Nanjing First Hospital from January 2016 to January 2023. The primary endpoint was the incidence of target vessel failure (TVF) post-re-PCI within 3 years. The secondary endpoints included each component of TVF. RESULTS: After propensity score matching, 161 matched pairs were enrolled. OCT guidance of re-PCI was associated with a significantly lower risk of TVF compared with angiographic guidance alone [hazard ratio (HR), 0.51; 95% confidence interval (CI), 0.31-0.83; P = 0.007] in patients with ISR. However, only 68.9% of patients with ISR met the final criteria of 'MLDMAX' post-re-PCI, which was associated with a lower risk of TVF compared with patients without meeting the OCT criteria (HR, 0.24; 95% CI, 0.11-0.54; P < 0.001), and satisfied the angiographic criteria (HR, 0.40; 95% CI, 0.19-0.85; P = 0.017). CONCLUSION: Compared with angiographic guidance, OCT guidance significantly reduced TVF risk following re-PCI for ISR lesions, especially for patients who met the final criteria of 'MLDMAX'.