What question did this study set out to answer?

August 16, 2022Open Access

Comparison between Optical Coherence Tomography and Intravascular Ultrasound in Primary Percutaneous Coronary Intervention for ST-segment Elevation Myocardial Infarction

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Why the study?

The impact of OCT-guided PCI on clinical outcomes in patients presenting with STEMI has been scarcely reported.

Does OCT-guided PCI improve target lesion failure compared to IVUS-guided PCI in patients presenting with STEMI?

Population

533 consecutive patients presenting with STEMI undergoing primary PCI within 12 h from symptom onset

Comparison

OCT-guided PCI vs IVUS-guided PCI

Design

Retrospective propensity score-matched study

Follow-up

Median 2.2 years

Authors

YMYuji MatsuwakiFujita Health University Hospital TMTakashi MuramatsuNihon University HOHideaki OtaFujita Health University Hospital

Discussion

Member takes

Implication

Should not yet change imaging choice in STEMI; leaves open whether OCT equals IVUS in unselected or higher-risk patients.

Key Points

To evaluate and compare the clinical outcomes of optical coherence tomography (OCT)-guided versus intravascular ultrasound (IVUS)-guided primary percutaneous coronary intervention (PCI) in patients presenting with ST-segment elevation myocardial infarction (STEMI).
Retrospectively analyzed consecutive STEMI patients (N=533) undergoing primary PCI within 12 hours of symptom onset between June 2016 and December 2020 (OCT: n=166; IVUS: n=367).
Evaluated target lesion failure (TLF)—defined as cardiac death, target vessel myocardial infarction, or target lesion revascularization—over a median follow-up of 2.2 years.
Conducted propensity score matching to generate 166 balanced pairs for comparative outcome analysis.
Prior to matching, the cumulative incidence of TLF did not differ significantly between OCT and IVUS groups (9.6% vs. 13.4%; p = 0.218), whereas cardiac mortality was lower with OCT (3.6% vs. 8.7%; p = 0.040).
Patients in the OCT-guided PCI group received a significantly larger volume of contrast media than those in the IVUS-guided group (median 200 vs. 165 mL; p < 0.001).
Following propensity score matching (166 patients per arm), no significant differences were observed between OCT- and IVUS-guided groups regarding TLF or any secondary clinical endpoints.

Structured PICO

Does OCT-guided PCI improve target lesion failure compared to IVUS-guided PCI in patients presenting with STEMI?

Population

533 consecutive patients presenting with STEMI (within 12 h of symptom onset) who underwent primary PCI, median age 68-71, 74-79% male, single-center in Japan. Excluded patients who used neither OCT/OFDI nor IVUS, or those who used both.

Intervention

Optical coherence tomography (OCT) or optical frequency domain imaging (OFDI) guided primary percutaneous coronary intervention (PCI)

Comparator

Intravascular ultrasound (IVUS) guided primary percutaneous coronary intervention (PCI)

Outcome

Target lesion failure (TLF) defined as a composite of cardiac death, target vessel myocardial infarction (re-infarction), or clinically-driven target lesion revascularization (CD-TLR) at median 2.2 years follow-upcomposite

OCT-guided primary PCI for STEMI yields comparable long-term clinical outcomes to IVUS-guided PCI, suggesting both are viable intracoronary imaging strategies.

Limitations

Retrospective, single-center, observational study
Did not compare results with conventional PCI with angiographic guidance
Pre-specified OCT use criteria and imaging guidance protocol might make it challenging to standardize the context of PCI procedure
Possibility of unmeasured confounders and selection biases cannot be excluded despite propensity score matching

Cite This Study

Matsuwaki et al. (2022) studied this question.

synapsesocial.com/papers/6a7f65bdf4a2ca5f602ffd7a https://doi.org/10.21203/rs.3.rs-1934868/v1

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Comparison between Optical Coherence Tomography and Intravascular Ultrasound in Primary Percutaneous Coronary Intervention for ST-segment Elevation Myocardial Infarction

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Comparison between Optical Coherence Tomography and Intravascular Ultrasound in Primary Percutaneous Coronary Intervention for ST-segment Elevation Myocardial Infarction

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

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