Usefulness of Frequency Domain Optical Coherence Tomography Compared with Intravascular Ultrasound as a Guidance for Percutaneous Coronary Intervention |
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| Authors: | In‐Cheol Kim M.D. Ph.D. Hyuck‐Jun Yoon M.D. Ph.D. Eun‐Seok Shin M.D Ph.D. Min‐Seok Kim Jincheol Park Ph.D. Yun‐Kyeong Cho M.D. Ph.D. Hyoung‐Seob Park M.D. Hyungseop Kim M.D. Ph.D. Chang‐Wook Nam M.D. Ph.D. Seong‐Wook Han M.D. Ph.D. Yoon‐Nyun Kim M.D. Ph.D. Kwon‐Bae Kim M.D. Ph.D. Seung‐Ho Hur M.D. Ph.D. |
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| Affiliation: | 1. Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea;2. Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, Ulsan, Korea;3. Department of Statistics, Keimyung University, Daegu, Korea |
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| Abstract: | Objectives To compare outcomes and rates of optimal stent placement between optical coherence tomography (OCT) and intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI). Background Unlike IVUS‐guided PCI, rates of clinical outcomes and optimal stent placement have not been well characterized for OCT‐guided PCI. Methods The study enrolled 290 patients who underwent implantation of a second generation drug eluting stent under OCT (122 patients) or IVUS (168 patients) guidance. The two groups were compared after adjusting for baseline differences using 1:1 propensity score matching (PSM) (114 patients in each group). Optimal stent placement was defined as achieving an adequate lumen (optimal minimum stent area [MSA > 4.85 mm2 for OCT, >5 mm2 for IVUS] or a final MSA ≥ 90% of the distal reference lumen area, without edge dissection, incomplete stent apposition, or tissue prolapse), or otherwise performing additional interventions to address suboptimal post‐stenting OCT or IVUS findings. The primary endpoint was one‐year cumulative incidence of major adverse cardiac events (MACE; cardiac death, myocardial infarction and target lesion revascularization). Definite or probable stent thrombosis (ST) rates were evaluated. Results In adjusted comparisons between OCT and IVUS groups, there was no significant difference in rates of MACE (3.5% vs. 3.5%, P = 1.000) and ST (0% vs. 0.9%, P = 1.000) at 1 year, optimal stent placement (89.5% vs. 92.1%, P = 0.492), and further intervention (7.9% vs.13.2%, P = 0.234), despite OCT significantly more frequently detecting tissue prolapse (97.4% vs. 47.4%, P < 0.001), and numerically more edge dissection (10.5% vs. 4.4%, P = 0.078) or incomplete stent apposition (48.2% vs. 36.8%, P = 0.082). Conclusions OCT guidance showed comparable results to IVUS in mid‐term clinical outcomes, suggesting that OCT can be an alternative tool for stent placement optimization. (J Interven Cardiol 2016;29:216–224) |
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