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OCT vs. IVUS for Complex Coronary Lesions
Quick Takes
- OCT-guided PCI showed a similar risk of a primary outcome event of death from cardiac causes, target-vessel MI, or ischemia-driven TVR as compared with IVUS-guided PCI.
- Given insufficient statistical power and inherent limitations from subgroup analyses, these findings should be considered hypothesis generating.
- Additional studies are indicated to identify patients who would benefit more from imaging-guided PCI and to overcome the barriers hindering wider adoption of these technologies in appropriate patients.
Study Questions:
What is the effectiveness and safety of optical coherence tomography (OCT)–guided versus intravascular ultrasound (IVUS)–guided percutaneous coronary intervention (PCI) for complex coronary artery lesions?
Methods:
The investigators conducted a prespecified, main subgroup analysis of complex coronary artery lesions in the OCTIVUS trial, which included unprotected left main disease, bifurcation disease, an aorto-ostial lesion, a chronic total occlusion, a severely calcified lesion, an in-stent restenotic lesion, a diffuse long lesion, or multivessel PCI. The primary endpoint was a composite of death from cardiac causes, target vessel–related myocardial infarction (MI), or ischemia-driven target-vessel revascularization (TVR). Cumulative-event probabilities were estimated with the use of the Kaplan–Meier methods. In time-to-first-event analyses, hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional-hazards models.
Results:
In 2,008 randomized patients, 1,475 (73.5%) underwent imaging-guided PCI for complex coronary artery lesions; 719 (48.7%) received OCT-guided and 756 (51.3%) received IVUS-guided PCI. At a median follow-up of 2.0 years, a primary endpoint event had occurred in 47 (6.5%) patients in the OCT-guided group and in 56 (7.4%) patients in the IVUS-guided group (HR, 0.87; 95% CI, 0.59–1.29; p = 0.50). These findings were consistent in adjusted analyses. The incidence of contrast-induced nephropathy was similar between two groups (1.9% vs. 1.5%; p = 0.46). The incidence of major procedural complications was lower in the OCT-guided group than the IVUS-guided group (1.7% vs. 3.4%; p = 0.03).
Conclusions:
The authors report that among patients with complex coronary artery lesions, OCT-guided PCI showed a similar risk of the primary composite event of death from cardiac causes, target-vessel–related MI, or TVR as compared with IVUS-guided PCI.
Perspective:
This prespecified subgroup analysis of the OCTIVUS trial compared the effectiveness and safety of OCT-guided PCI versus IVUS-guided PCI in patients with complex coronary artery lesions and reports that OCT-guided PCI showed a similar risk of a primary outcome event of death from cardiac causes, target-vessel MI, or ischemia-driven TVR as compared with IVUS-guided PCI. Given insufficient statistical power and inherent limitations from subgroup analyses, these findings should be considered hypothesis generating. Additional studies are indicated to identify patients who would benefit more from imaging-guided PCI and to overcome the barriers hindering wider adoption of these technologies in appropriate patients.
Clinical Topics: Noninvasive Imaging, Echocardiography/Ultrasound
Keywords: Tomography, Optical Coherence, Ultrasonography
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