Optical Coherence Tomography for Stent Guidance Improves Outcomes in Complex PCI Cases: ESC Congress 2024 - EMJ

Optical Coherence Tomography for Stent Guidance Improves Outcomes in Complex PCI Cases: ESC 2024

1 Mins
Cardiology

LATE BREAKING data from the OCCUPI trial were presented at the European Society of Cardiology (ESC) Congress 2024, revealing that use of optical coherence tomography (OCT) to guide drug-eluting stent implantation in patients with complex coronary lesions during percutaneous coronary intervention (PCI) reduced the combined risk for a composite of cardiac outcomes compared to traditional angiography-guided PCI. 

Whilst angiography is the most frequently used method for PCI stent guidance, OCT-guided PCI has greater resolution and accuracy. Previous studies have also suggested that OCT-guided PCI yields more detailed information on the coronary vessels, plaques, and implanted stents than angiography-guided PCI. 

The OCCUPI trial sought to evaluate the impact of OCT-guided PCI on a composite of outcomes including stent thrombosis, target vessel revascularisation, myocardial infarction (MI), and cardiac death. 

In total, 1,604 patients aged 19 years with anatomically complex lesions requiring PCI using drug-eluting stents were enrolled from 20 centres in the Republic of Korea. Individuals were randomised to either OCT-guided (n=803) or angiography-guided (n=801) intervention. Completed 1-year follow-up was achieved for 99% of patients (n=1,588). 

At 1-year, those who received OCT-guided intervention had a 38% combined reduction in risk for the composite of cardiac outcomes (n=37) compared to angiography-guided intervention (n=59). Furthermore, the investigators found that those who received OCT-guided intervention were 64% less likely to have a spontaneous MI (excluding periprocedural MI) than those in the angiography-guided group (0.9% versus 2.4%, respectively) and were 64% less likely to need target vessel revascularisation than those in the angiography-guided group (1.5% versus 4.1%, respectively). No significant difference in the incidence of post-PCI contrast-induced nephropathy occurred between the two groups. 

Lead study investigator, Byeong-Keuk Kim, Yonsei University Severance Hospital, Seoul, Korea, commented: “Our findings provide more evidence that OCT guidance of PCI procedures in patients with complex lesions has a greater impact on improving their lives than conventional angiography guidance.” Kim suggested that based on the results of OCCUPI, a detailed standard for optimising the use of OCT in PCI for complex cases needs to be established moving forwards. 

Darcy Richards, EMJ 

Reference 

Kim B-K. OCCUPI – Optical coherence tomography-guided coronary intervention in patients with complex lesions. ESC Congress 2024, 2 September 2024. 

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