Optical coherence tomography-guided versus intravascular ultrasound-guided percutaneous coronary intervention in patients with acute myocardial infarction

Oh-Hyun Lee; Seok-Jae Heo; Thomas W Johnson; Yongcheol Kim; Deok-Kyu Cho; Jung-Sun Kim; Byeong-Keuk Kim; Donghoon Choi; Myeong-Ki Hong; Yangsoo Jang; Myung Ho Jeong; Investigators for KAMIR

doi:10.1016/j.rec.2023.11.014

Optical coherence tomography-guided versus intravascular ultrasound-guided percutaneous coronary intervention in patients with acute myocardial infarction

Rev Esp Cardiol (Engl Ed). 2023 Dec 16:S1885-5857(23)00344-4. doi: 10.1016/j.rec.2023.11.014. Online ahead of print.

[Article in English, Spanish]

Authors

Affiliations

¹ Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Republic of Korea.
² Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea.
³ Bristol Heart Institute, Bristol, United Kingdom.
⁴ Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Republic of Korea. Electronic address: yongcheol@yuhs.ac.
⁵ Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea.
⁶ Department of Cardiology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea.
⁷ Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea. Electronic address: myungho@chollian.net.

PMID: 38110116
DOI: 10.1016/j.rec.2023.11.014

Abstract

Introduction and objectives: Optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) yields clinical outcomes comparable to intravascular ultrasound (IVUS)-guided PCI in patients with stable ischemic heart disease. However, there is a scarcity of data comparing the clinical outcomes of OCT-guided and IVUS-guided PCI in the setting of acute myocardial infarction (AMI). We sought to compare the clinical outcomes of OCT-guided vs IVUS-guided PCI for patients with AMI in the era of second-generation drug-eluting stent (DES).

Methods: We identified 5260 consecutive patients who underwent PCI with a second-generation DES for AMI under IVUS or OCT guidance from pooled data derived from a series of Korean AMI registries between 2011 and 2020. The primary endpoint was the 1-year rate of target lesion failure, defined as a composite of cardiac death, target vessel myocardial infarction, or ischemia-driven target lesion revascularization.

Results: A total of 535 (10.2%) and 4725 (89.8%) patients were treated under OCT and IVUS guidance, respectively. The 1-year target lesion failure rates were comparable between the OCT and IVUS groups before and after propensity score matching (hazard ratio, 0.92; 95%CI, 0.42-2.05, P=.84). The OCT utilization rate did not exceed 5% of total patients treated with second-generation DES implantation during the study period. The primary factors for the selection of OCT over IVUS were the absence of chronic kidney disease, non-left main vessel disease, single-vessel disease, stent diameter <3mm, and stent length ≤ 25mm.

Conclusions: OCT-guided PCI in patients with AMI treated with a second-generation DES provided comparable clinical outcomes for 1-year target lesion failure compared with IVUS-guided PCI.

Keywords: Acute myocardial infarction; Drug-eluting stent; Ecografía intravascular; Infarto agudo de miocardio; Intravascular ultrasound; Optical coherence tomography; Stent liberador de fármacos; Tomografía de coherencia óptica.