OCT enhances PCI in non–ST-segment elevation acute coronary syndrome patients
medwireNews: Guiding percutaneous coronary intervention (PCI) with optical coherence tomography (OCT) in addition to angiography is beneficial for patients with non–ST-segment elevation acute coronary syndromes, indicate findings from the DOCTORS study.
The study (Does Optical Coherence Tomography Optimize Results of Stenting), presented at the ESC congress 2016 in Rome Italy and simultaneously published in Circulation, showed that OCT guidance led to a change in procedural strategy in 50% of cases, compared with just 22.5% of cases involving fluoroscopy alone.
Improvement of the procedure as a result led to significantly better functional outcome in the 120 patients in the OCT-guided group, who had an average postprocedure fractional flow reserve (FFR) of 0.94 compared with 0.92 for the 120 patients whose PCI was guided by fluoroscopy alone.
And OCT guidance increased the percentage of patients whose FFR was 0.90 or above, at 82.5% versus 64.2%.
“The benefit was obtained at the cost of a longer procedure with higher fluoroscopy time and more contrast medium, but without an increase in periprocedural MI [myocardial infarction] or kidney dysfunction”, notes the team, led by Nicolas Meneveau (University Hospital Jean Minjoz, Besançon, France).
They report that the change in physician decision-making among patients in the OCT group was mainly driven by the optimisation of stent expansion.
OCT performed immediately after stent implantation was significantly more likely to reveal stent underexpansion than fluoroscopy alone (42.0 vs 10.8%) and showed stent malapposition, which was not possible with fluoroscopy, in 32% of cases. It also allowed edge dissection to be detected significantly more readily (37.5 vs 4.0%).
As a result, post-stent overdilation was used significantly more often in the OCT group than the fluoroscopy only group, at a rate of 43.0% versus 12.5%, respectively, and with significantly lower residual stenosis, at 7.0% versus 8.7%.
OCT before stent implantation also significantly increased detection of thrombi (69 vs 47%) and calcification (45.8 vs 9.0%), which resulted in more frequent antiplatelet use in the OCT group (53.0 vs 35.8%).
There was no significant difference in the rate of type 4a MI, at 33% in the OCT group versus 40% in the fluoroscopy-guided group, and rates of procedural complications and acute kidney injury were identical for the two groups, at 5.8% and 1.6%, respectively.
In an editorial accompanying the paper, William Wijns (National University of Ireland Galway) and Stylianos Pyxaras (Klinikum Coburg, Germany) say the research “is an important milestone in the journey to accumulating sufficient global evidence to support the role of OCT-guidance eventually during complex PCI and to extend the Practice Guidelines recommendations supporting its use.”
They conclude that it “remains to be investigated whether the use of additional interventions prompted by OCT findings will translate into improve clinical outcomes.”
By Lucy Piper
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