Optical coherence tomography-guided percutaneous coronary intervention in acute coronary syndrome patients with complex lesions: a subgroup analysis of the randomised OCCUPI Trial
Abstract
BACKGROUND
The role of optical coherence tomography (OCT) guidance during percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) remains inconclusive.
AIMS
This study aimed to evaluate the impact of OCT-guided PCI in ACS patients with complex lesions.
METHODS
The Optical CoherenCe Tomography-gUided Coronary Intervention in Patients With Complex Lesions (OCCUPI) Trial compared PCI with OCT guidance versus angiography guidance in patients who required drug-eluting stent implantation for complex lesions. This post hoc analysis focused on participants presenting with ACS. The primary outcome was 1-year major adverse cardiac events (a composite of cardiac death, myocardial infarction, stent thrombosis, or ischaemia-driven target vessel revascularisation).
RESULTS
Out of 1,604 randomised patients, 790 (49.3%) and 814 (50.7%) presented with ACS and chronic coronary syndrome (CCS), respectively. Among patients with ACS, the incidence of the primary outcome was 4.9% in the OCT-guided group and 9.5% in the angiography-guided group (hazard ratio [HR] 0.50, 95% confidence interval [CI]: 0.29-0.87; p=0.011). Among patients with CCS, its incidence was 4.4% and 5.4%, respectively (HR 0.80, 95% CI: 0.43-1.50; p=0.479). No significant interaction between clinical presentation and imaging guidance strategy was observed for the primary outcome (pinteraction=0.273). Among patients with ACS randomised to OCT guidance, the achievement of stent optimisation by OCT…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 1,604 participants or records.
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