ILUMIEN III (OPTIMIZE PCI): Outcomes in OCT-Guided vs. IVUS-Guided PCI
Optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) results in similar minimal stent area compared to intravascular ultrasound (IVUS)-guided PCI, according to the results of the ILUMIEN III (OPTIMIZE PCI) Trial presented Oct. 30 at TCT 2016 and simultaneously published in The Lancet.
Ziad A. Ali, MD, et al., conducted a multicenter, prospective, randomized, controlled trial at 29 sites in eight countries, evaluating post-PCI minimal stent area in 450 patients receiving either OCT-guided, IVUS-guided or angiography-guided stent implantation. Between May 2015 and April 2016, 415 final OCT acquisitions were analyzed for the primary endpoint.
The results of the study showed that the minimal stent area OCT-guided PCI was non-inferior to IVS-guidance, but resulted in fewer untreated major dissections and major malapposition. OCT-guided PCI was also associated with improved stent expansion and procedural success compared to angiography-guided PCI. The final MSA (median [25 percent, 75 percent]) was 5.79 [4.54, 7.34] mm2 with OCT-guidance, 5.89 [4.67, 7.80] mm2 with IVUS-guidance and 5.49 [4.39, 6.59] mm2 with angiography-guidance. Clinical follow-up to one-year is ongoing in order to determine the clinical relevance of these OCT-based findings, as there were only six (1.3 percent) procedural and seven (1.6 percent) 30-day MACE events, with no significant differences between groups.
Ali, et al., note that “these results are encouraging, but further study is still needed to determine whether the advantages we have identified by utilizing OCT-guidance will impact clinical outcome.”
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