OCT-guided PCI reduced the 2-year risk of serious MACE compared with angiography-guided PCI in complex lesions (3.1% vs 4.9%; HR 0.63; 95% CI 0.40-0.99; P=0.04).
RCT (n=1,973)
Yes
Does OCT-guided coronary stent implantation improve minimal stent area and reduce adverse cardiovascular events compared to angiography-guided implantation in patients with complex angiographic lesions?
In patients with complex coronary lesions, OCT-guided PCI improves minimal stent area and reduces serious MACE compared to angiography guidance, though it does not significantly reduce target-vessel failure.
Effect estimate: HR 0.63 (95% CI 0.40-0.99)
Absolute Event Rate: 3.1% vs 4.9%
p-value: p=0.04
BACKGROUND: ILUMIEN IV was the first large-scale, multicenter, randomized trial comparing optical coherence tomography (OCT)-guided vs angiography-guided stent implantation in patients with high-risk clinical characteristics and/or complex angiographic lesions. OBJECTIVES: The authors aimed to specifically examine outcomes in the complex angiographic lesions subgroup. METHODS: From the original trial population (N = 2,487), high-risk patients without complex angiographic lesions were excluded (n = 514). Complex angiographic lesion characteristics included: 1) long or multiple lesions with intended total stent length ≥28 mm; 2) bifurcation lesion with intended 2-stent strategy; 3) severely calcified lesion; 4) chronic total occlusion; or 5) in-stent restenosis. The study endpoints were: 1) final minimal stent area (MSA); 2) 2-year composite of serious major adverse cardiovascular events (MACEs) (cardiac death, target-vessel myocardial infarction MI, or stent thrombosis); and 3) 2-year effectiveness, defined as target-vessel failure (TVF), a composite of cardiac death, target-vessel MI, or ischemia-driven target-vessel revascularization. RESULTS: The postpercutaneous coronary intervention (PCI) MSA was larger in the OCT-guided (n = 992) vs angiography-guided (n = 981) group (5.56 ± 1.95 mm2 vs 5.26 ± 1.81 mm2; difference, 0.30; 95% CI: 0.14-0.47; P < 0.001). Compared with angiography-guided PCI, OCT-guided PCI resulted in a lower risk of serious MACE (3.1% vs 4.9%; HR: 0.63; 95% CI: 0.40-0.99; P = 0.04). TVF was not significantly different between groups (7.3% vs 8.8%; HR: 0.82; 95% CI: 0.59-1.12; P = 0.20). CONCLUSIONS: In complex angiographic lesions, OCT-guided PCI led to a larger MSA and reduced the serious MACE, the composite of cardiac death, target-vessel MI, or stent thrombosis, compared with angiography-guided PCI at 2 years, but did not significantly improve TVF. (Optical Coherence Tomography Guided Coronary Stent Implantation Compared to Angiography: A Multicenter Randomized Trial in PCI; NCT03507777).
Ali et al. (Wed,) conducted a rct in Complex angiographic lesions (n=1,973). OCT-guided coronary stent implantation vs. Angiography-guided coronary stent implantation was evaluated on 2-year composite of serious major adverse cardiovascular events (cardiac death, target-vessel MI, or stent thrombosis) (HR 0.63, 95% CI 0.40-0.99, p=0.04). OCT-guided PCI reduced the 2-year risk of serious MACE compared with angiography-guided PCI in complex lesions (3.1% vs 4.9%; HR 0.63; 95% CI 0.40-0.99; P=0.04).
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