DOCTORS: Is There a Role For OCT-Guided PCI in NSTEACS Patients?
In patients with non–ST-segment elevation acute coronary syndromes (NSTEACS), optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) may be associated with higher post-procedure fractional flow reserve than PCI guided by angiography alone, according to findings from the DOCTORS study presented Aug. 29 at ESC Congress 2016 in Rome and simultaneously published in Circulation.
The multicenter, randomized study involving 240 patients with NSTEACS compared OCT-guided PCI to fluoroscopy-guided PCI. The primary end point was the functional result of PCI assessed by the measure of post-PCI fractional flow reserve. Secondary end points included procedural complications and type 4a periprocedural myocardial infarction. Safety was assessed by the rate of acute kidney injury.
Results showed OCT use led to a change in procedural strategy in 50 percent of the patients in the OCT-guided group. The primary endpoint was improved in the OCT-guided group, with a significantly higher fractional flow reserve value (0.94±0.04 vs. 0.92±0.05, P=0.005) compared with the angiography-guided group. OCT did not increase periprocedural complications, type 4a myocardial infarction or acute kidney injury. Researchers noted that post-PCI OCT revealed stent underexpansion in 42 percent of patients, stent malapposition in 32 percent, incomplete lesion coverage in 20 percent, and edge dissection in 37.5 percent, which led to more frequent use of poststent overdilation in the OCT-guided group vs. the angiography-guided group (43 percent vs. 12.5 percent, respectively).
“These results suggest that there may be a role for OCT as a complement to fluoroscopy for the guidance of PCI procedures in NSTEACS,” according to the study authors. They suggest additional prospective studies with clinical endpoints before OCT guidance is incorporate as a standard option for treating patients with NSTEACS.
Keywords: ESC Congress, Physicians, Stents, Tomography, Optical Coherence, Angina, Stable, Angiography
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