Optical Coherence Tomography Versus Intravascular Ultrasound and Angiography to Guide Percutaneous Coronary Interventions

Abstract

Background: Specific algorithms for use of optical coherence tomography (OCT) to guide percutaneous coronary intervention (PCI) are scarce. Also, the relative benefits of intravascular imaging guidance have not been tested against an optimized angiography-guided PCI strategy. In iSIGHT (Optical Coherence Tomography Versus Intravascular Ultrasound and Angiography to Guide Percutaneous Coronary Interventions), we aimed to investigate whether OCT-guided PCI achieves noninferior stent expansion compared with intravascular ultrasound (IVUS) guidance and if both imaging modalities lead to superior stent expansion compared with an optimized angiography-based strategy. Methods: Patients ≥18 years old undergoing PCI for ≥1 lesion in native coronaries of 2.25 to 4.00 mm in diameter were randomized 1:1:1 to OCT-, IVUS-, or angiography-guided PCI. Predetermined guidance protocols were applied in all groups. An external elastic membrane–based protocol was used for stent sizing by OCT and IVUS. The primary end point was noninferiority of stent expansion (minimum stent area ≥90% of the average reference lumen area), measured by post-PCI OCT, in OCT-guided versus IVUS-guided PCI (noninferiority margin, 6.5%). Results: One hundred fifty-one patients (156 lesions) were randomly allocated to OCT (51 lesions [32.7%]), IVUS (52 lesions [33.3%]), or angiography (53 lesions [34.0%]). Stent expansion with OCT guidance (98.01±16.14%) was noninferior to IVUS (91.69±15.75%; 1-sided lower 95% CI, 0.55 mm 2 ; P non-inferiority <0.001) and superior to angiography (90.53±14.84%, P =0.041). IVUS and angiography obtained similar stent expansions ( P =0.921). Stent edge dissection and periprocedural complication rates were not significantly different among the groups. Conclusions: Stent expansion with OCT guidance using a dedicated external elastic membrane–based sizing strategy was noninferior to that achieved with IVUS and superior to an optimized angiographic strategy. REGISTRATION: URL: plataformabrasil.saude.gov.br ; Unique identifier: 69968417.8.0000.5462.

Outcomes of intravascular ultrasound versus optical coherence tomography guided percutaneous coronary angiography: A meta regression‐based analysis

“…Finally, after screening 298 full-text articles, a total of seven studies with 5917 participants were included (2075 patients in the OCT guidance group and 3842 patients in the IVUS guidance group). [18][19][20][21][22][23][24] The quality of the studies included was moderate. Among the seven studies included, half were observational studies with matched cohorts, increasing the potential risk of selection bias.…”

“…[22][23][24] The remaining four were RCTs. [18][19][20][21] Quality assessment findings of the included studies are summarized in Section S3, Figures S1 and S2.…”

“…Six out of seven studies reported data on MACE 18,[20][21][22][23][24] and MI. [18][19][20][21]23,24 Cardiac mortality was assessed in four out of seven studies.…”

“…Six out of seven studies reported data on MACE 18,[20][21][22][23][24] and MI. [18][19][20][21]23,24 Cardiac mortality was assessed in four out of seven studies. 18,19,21,24 Six out of seven studies assessed all-cause mortality during short-term follow-up (in-hospital to 30 days) among the OCT and IVUS groups.…”

“…[18][19][20][21]23,24 Cardiac mortality was assessed in four out of seven studies. 18,19,21,24 Six out of seven studies assessed all-cause mortality during short-term follow-up (in-hospital to 30 days) among the OCT and IVUS groups. 18,19,[21][22][23][24] TLR was reported in four studies, 18,20,21,24 ST in three studies, 18,20,24 and stroke was reported in only two studies.…”