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

Authors	KALA Petr CERVINKA P. JAKL M. KAŇOVSKÝ Jan KUPEC A. SPACEK R. KVASNAK M. POLOCZEK Martin CERVINKOVA M. BEZERRA H. VALENTA Z. ATTIZZANI G.F. SCHNELL A. HONG L. COSTA M.A.
Year of publication	2018
Type	Article in Periodical
Magazine / Source	International Journal of Cardiology
MU Faculty or unit	Faculty of Medicine
Citation
Doi	http://dx.doi.org/10.1016/j.ijcard.2017.10.059
Field	Cardiovascular diseases incl. cardiosurgery
Keywords	Optical coherence tomography; OCT; Primary PCI; ST-segment elevation myocardial infarction; Drug-eluting stents
Description	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 ninemonths 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. (C) 2017 Elsevier B.V. All rights reserved.