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