Optical coherence tomography-guided angioplasty reduces adverse events compared to angiography guidance

1. Major cardiac events were significantly lower in the OCT-guided group compared to the angiography-guided group.

2. Stroke, bleeding events, and nephropathy showed no significant difference between groups.

Evidence Rating Level: 1 (Excellent)

Study Rundown: The clinical benefits of optical coherence tomography (OCT) in guiding percutaneous coronary intervention (PCI) for patients with complex coronary lesions remain unclear. This randomized controlled trial aimed to compare the clinical outcomes of OCT-guided PCI versus angiography-guided PCI in patients over a 1-year period. The primary outcome of this study was the rate of major adverse cardiac events, including cardiac death, myocardial infarction, and stent thrombosis, while a key secondary outcome was the incidence of complications such as stroke and bleeding. According to study results, patients undergoing OCT-guided PCI had a significantly reduced rate of major adverse cardiac events compared to those who underwent angiography-guided PCI. Although this study was well done, it was limited by its open-label design, which may have introduced performance bias among clinicians and participants.

Click to read the study in The Lancet

Relevant Reading: CT or Invasive Coronary Angiography in Stable Chest Pain

In-depth [randomized controlled trial]: Between Jan 9, 2019, and Sept 22, 2022, 6128 patients were screened for eligibility across 20 hospitals in South Korea. Included were patients aged 19–85 years who required PCI with drug-eluting stents for complex coronary lesions. Altogether, 1604 patients (803 in OCT-guided PCI and 801 in angiography-guided PCI) were included in the final analysis. The primary outcome of major adverse cardiac events at 1 year was significantly lower in the OCT-guided group compared to the angiography-guided group (5% vs. 7%, hazard ratio [HR] 0.62, 95% confidence interval [CI] 0.41-0.93, p=0.023). The secondary outcome of stroke, bleeding events, and contrast-induced nephropathy showed no significant differences between the two groups. Overall, findings from this study suggest that OCT-guided PCI provides clinical benefits over angiography-guided PCI for complex coronary lesions.

Image: PD

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