OCT STEMI: Optical Coherence Tomography Guidance During Primary PCI in AMI
The OCT STEMI trial presented Sept. 14 at TCT 2014 looked at optical coherence tomography (OCT) guidance during drug-eluting stent implantation in patients with ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), and was the first randomized trial to look at serial OCT in primary PCI, but ultimately showed that larger randomized trials are needed on this topic to assess potential benefit.
Led by principal investigator Pavel Červinka, MD, PhD, First Department of Cardio-Angiology and Internal Medicine, Faculty Hospital Hradec Králové, Czech Republic, the trial enrolled 201 patients, who were pre-treated with aspirin, heparin and clopidogrel. After performing a diagnostic angiography, individuals were randomly assigned either to primary PCI alone (N=96) or to primary PCI with OCT guidance (N=105). Results showed that baseline demographic and procedural characteristics were well balanced in both groups. After analyzing the OCT data, the investigators found that more stents were used in the OCT group and suboptimal results were found in a third of patients in this group.
Further, the rate of major adverse cardiac events was comparable at 30 days and nine-months in both groups (p=NS). The occurrence of binary restenosis was low in both groups (2 percent vs. 3 percent; p=NS). An analysis of nine-month OCT data also showed significantly smaller area stenosis (p=0.0011) and trended to a lesser number of uncovered struts (p=0.0655) in OCT guided primary PCI.
Moving forward, Pavel and his colleagues ultimately advocate for larger randomized trials with longer-term follow-up on this topic.
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