Optical coherence tomography-guided PCI linked to better 5-year survival

  • Jones DA & al.
  • JACC Cardiovasc Interv
  • 23 Jul 2018

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • Optical coherence tomography (OCT) and intravascular ultrasound (IVUS) guidance during percutaneous coronary intervention (PCI) are both associated with lower long-term all-cause mortality than angiographic guidance alone.
  • Editorial discusses confounders, argues “We need more data in order to confirm that OCT-guided PCI is superior to angiography alone.” 

Why this matters

  • No data link OCT to long-term post-PCI clinical outcomes, according to authors.

Key results

  • Median follow-up was 4.8 years.
  • All-cause mortality for entire population (adjusted): 
    • OCT vs angiography: HR, 0.48 (95% CI, 0.26-0.81; P=.001);
    • IVUS: HR, 0.72 (95% CI, 0.32-0.93; P=.012);
    • OCT vs IVUS: 0.85 (95% CI, 0.62-1.26, P=.45).
  • All-cause mortality for propensity-matched population (adjusted):
    • OCT vs angiography: HR, 0.39 (95% CI, 0.21-0.77; P=.0008);
    • OCT vs IVUS: HR, 0.85 (95% CI, 0.63-1.34; P=.43).
  • There were fewer in-hospital major adverse cardiac events with OCT and IVUS vs angiography.

Study design

  • Prospective multicenter cohort study of Pan-London PCI registry, 2005-2015 (n= 87,166).
  • Participants underwent elective or urgent PCI; those receiving primary or pressure wire-guided PCI were excluded.
  • Researchers compared all-cause mortality with use of OCT, IVUS, and angiography alone.
  • Funding: None disclosed; some authors report industry ties.

Limitations

  • Guidance left to physician discretion.
  • No target lesion-related endpoints.

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