Comparison between Optical Coherence Tomography and Intravascular Ultrasound in Primary Percutaneous Coronary Intervention for ST-segment Elevation Myocardial Infarction

Abstract

Background: Optical coherence tomography (OCT) may have advantages in not only identifying etiology but also optimizing stent implantation due to its higher spatial resolution compared to intravascular ultrasound (IVUS) in contemporary percutaneous coronary intervention (PCI) for acute coronary syndrome. However, the impact of OCT-guided PCI on clinical outcomes in patients presenting with ST-segment elevation myocardial infarction (STEMI) has been scarcely reported.Methods: We retrospectively studied consecutive 533 patients presenting with STEMI who underwent either OCT-guided or IVUS-guided primary PCI (within 12 h from symptom onset) between June 2016 and December 2020. The primary endpoint was a target lesion failure (TLF), including cardiac death, target vessel myocardial infarction (re-infarction), or target lesion revascularization. Propensity score (PS) matching was performed for fair comparisons between OCT-guided and IVUS-guided PCI.Results: The patients were younger, and left ventricular ejection fraction and estimated glomerular filtration rate were significantly higher in the OCT group (166 patients, 31.1%) than in the IVUS group (367 patients, 68.9%). Killip class IV and left main disease were more common in the IVUS group than in the OCT group, while the peak level of creatine kinase was comparable between the two groups (median; 1,953 vs 1,603 U/L). Contrast volume was significantly higher in the OCT group than in the IVUS group (200 vs. 165 mL; p < 0.001). The cumulative incidence of TLF within median 2.2 years did not differ between the OCT and the IVUS groups (9.6% vs. 13.4%; p = 0.218), whereas cardiac mortality was significantly higher in the IVUS group than in the OCT group (8.7% vs. 3.6%; p = 0.040). After the PS matching (166 patients in each group), no differences in TLF and other clinical outcome measures were observed between the two groups.Conclusions: OCT-guided PCI showed comparable clinical outcomes with IVUS-guided PCI in selected patients presenting with STEMI.