Optical coherence tomography to guide percutaneous coronary intervention

A retrospective case series compared 335 matched pairs of patients undergoing percutaneous coronary intervention (PCI) with either angiographic guidance alone or a combination of angiographic and frequency-domain optical coherence tomography (FD OCT) guidance. Cardiac death or myocardial infarction (MI) were less frequent in patients treated by PCI with a combination of angiographic and FD OCT guidance than in those treated by PCI with angiographic guidance alone over a follow-up period of 1 year. There were 15 cardiac deaths and 29 MIs in the angiography-only group, and 4 cardiac deaths and 18 MIs in the combined angiography and FD-OCT group; odds ratio 0.49; 95% confidence interval 0.25 to 0.96, p=0.037.

A randomised controlled trial comparing FD OCT against intravascular ultrasound for PCI optimisation in 70 patients reported that there was inferior stent expansion, both focal (65% versus 80%, p=0.002) and diffuse (84% versus 99%, p=0.003), when FD OCT had been used for guidance. PCI guided by FD OCT also showed a significant increase in residual stent-edge plaque burden (51% versus 42%, p<0.001). There were no significant differences in stent apposition.

In the retrospective case series comparing 335 matched pairs of patients undergoing PCI with either angiographic guidance or a combination of angiographic and FD OCT guidance, FD OCT led to additional interventions (further stenting and additional balloon dilation) in 116 patients (35%).

In a case series of 40 patients in whom OCT was performed to evaluate ambiguous or intermediate lesions, 60% (24 out of 40) were treated by PCI and 40% (16 out of 40) had PCI deferred. None of the patients for whom PCI was deferred had a coronary event within an average follow-up of 4.6 months.

The specialist advisers listed a key efficacy outcome as a change in diagnosis or management due to OCT imaging results. They cited as examples identifying culprit or non-culprit plaques in acute coronary syndromes, identifying intracoronary or intra-stent thrombus, identifying dissections and complications after stenting, examining stent deformation and conformation, identifying modes of stent failure including neoatherogenesis, and documenting stent tissue coverage.