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OCT guidance during stent implantation in primary PCI: A randomized multicenter study with nine months of optical coherence tomography follow-up

P. Kala, P. Cervinka, M. Jakl, J. Kanovsky, A. Kupec, R. Spacek, M. Kvasnak, M. Poloczek, M. Cervinkova, H. Bezerra, Z. Valenta, GF. Attizzani, A. Schnell, L. Hong, MA. Costa,

. 2018 ; 250 (-) : 98-103. [pub] 20171021

Language English Country Netherlands

Document type Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial

Persistent link   https://www.medvik.cz/link/bmc18033622

AIMS: To assess the possible merits of optical coherence tomography (OCT) guidance in primary percutaneous coronary intervention (pPCI). METHODS AND RESULTS: 201 patients with ST-elevation myocardial infarction (STEMI) were enrolled in this study. Patients were randomized either to pPCI alone (angio-guided group, n=96) or to pPCI with OCT guidance (OCT-guided group, n=105) and also either to biolimus A9 or to everolimus-eluting stent implantation. All patients were scheduled for nine months of follow-up angiography and OCT study. OCT guidance led to post-pPCI optimization in 29% of cases (59% malapposition and 41% dissections). No complications were found related to the OCT study. OCT analysis at nine months showed significantly less in-segment area of stenosis (6% [-11, 19] versus 18% [3, 33]; p=0.0002) in favor of the OCT-guided group. The rate major adverse cardiovascular events were comparable at nine months in both groups (3% in the OCT group versus 2% in the angio-guided group; p=0.87). CONCLUSIONS: This study demonstrates the safety of OCT guidance during pPCI. The use of OCT optimized stent deployment in 1/3 of patients in this clinical scenario and significantly reduced in-segment area of stenosis at nine months of follow-up. Whether such improvements in OCT endpoints will have a positive impact on late clinical outcomes, they demand both a larger and longer-term follow-up study.

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$a Kala, Petr $u Department of Cardiology and Internal Medicine, University Hospital Brno, Brno, Czech Republic; Medical Faculty of Masaryk University, Brno, Czech Republic.
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$a OCT guidance during stent implantation in primary PCI: A randomized multicenter study with nine months of optical coherence tomography follow-up / $c P. Kala, P. Cervinka, M. Jakl, J. Kanovsky, A. Kupec, R. Spacek, M. Kvasnak, M. Poloczek, M. Cervinkova, H. Bezerra, Z. Valenta, GF. Attizzani, A. Schnell, L. Hong, MA. Costa,
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$a AIMS: To assess the possible merits of optical coherence tomography (OCT) guidance in primary percutaneous coronary intervention (pPCI). METHODS AND RESULTS: 201 patients with ST-elevation myocardial infarction (STEMI) were enrolled in this study. Patients were randomized either to pPCI alone (angio-guided group, n=96) or to pPCI with OCT guidance (OCT-guided group, n=105) and also either to biolimus A9 or to everolimus-eluting stent implantation. All patients were scheduled for nine months of follow-up angiography and OCT study. OCT guidance led to post-pPCI optimization in 29% of cases (59% malapposition and 41% dissections). No complications were found related to the OCT study. OCT analysis at nine months showed significantly less in-segment area of stenosis (6% [-11, 19] versus 18% [3, 33]; p=0.0002) in favor of the OCT-guided group. The rate major adverse cardiovascular events were comparable at nine months in both groups (3% in the OCT group versus 2% in the angio-guided group; p=0.87). CONCLUSIONS: This study demonstrates the safety of OCT guidance during pPCI. The use of OCT optimized stent deployment in 1/3 of patients in this clinical scenario and significantly reduced in-segment area of stenosis at nine months of follow-up. Whether such improvements in OCT endpoints will have a positive impact on late clinical outcomes, they demand both a larger and longer-term follow-up study.
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$a Cervinka, Pavel $u Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital, UJEP Usti nad Labem, Usti nad Labem, Czech Republic. Electronic address: pavel.cervinka@kzcr.eu.
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$a Jakl, Martin $u First Department of Cardio-Angiology and Internal Medicine, Faculty Hospital Hradec Kralove, Hradec Kralove, Czech Republic. $7 xx0135493
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$a Kanovsky, Jan $u Department of Cardiology and Internal Medicine, University Hospital Brno, Brno, Czech Republic; Medical Faculty of Masaryk University, Brno, Czech Republic.
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$a Kupec, Andrej $u Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital, UJEP Usti nad Labem, Usti nad Labem, Czech Republic.
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$a Spacek, Radim $u Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital, UJEP Usti nad Labem, Usti nad Labem, Czech Republic.
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$a Kvasnak, Martin $u Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital, UJEP Usti nad Labem, Usti nad Labem, Czech Republic.
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$a Poloczek, Martin $u Department of Cardiology and Internal Medicine, University Hospital Brno, Brno, Czech Republic.
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$a Cervinkova, Michaela $u Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital, UJEP Usti nad Labem, Usti nad Labem, Czech Republic; First Department of Cardio-Angiology and Internal Medicine, Faculty Hospital Hradec Kralove, Hradec Kralove, Czech Republic.
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$a Bezerra, Hiram $u Harrington Heart &Vascular Institute, University Hospitals Case Medical Center, Cleveland, USA.
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$a Valenta, Zdenek $u Institute of Computer Science, Department of Statistical Medelling, Czech Academy of Sciences, Prague, Czech Republic.
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$a Attizzani, Guilherme F $u Harrington Heart &Vascular Institute, University Hospitals Case Medical Center, Cleveland, USA.
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$a Schnell, Audrey $u Harrington Heart &Vascular Institute, University Hospitals Case Medical Center, Cleveland, USA.
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$a Hong, Lu $u Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.
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$a Costa, Marco A $u Harrington Heart &Vascular Institute, University Hospitals Case Medical Center, Cleveland, USA.
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