OCT STEMI: Imaging-Guided PCI Shows Promise

Using optical coherence tomography (OCT) to guide PCI yields comparable MACE rates and fewer uncovered struts than primary PCI alone in patients with STEMI, according to data presented at TCT 2014.

Pavel Červinka, MD, PhD, of Faculty Hospital Hradec Králové in the Czech Republic, and colleagues pretreated 201 patients with aspirin, heparin and clopidogrel. Following angiography, the researchers randomly assigned 96 patients to primary PCI alone and 105 patients to primary PCI guided by OCT. Patients were treated with Promus (Boston Scientific) or Biomatrix (Biosensors) stents. Both groups had similar baseline demographic and procedural characteristics.

At 9 months, there were no differences between the two groups in the rate of MACE (composite of death, MI and ischemia-driven target vessel revascularization), nor for the individual components of this outcome, or for stent thrombosis.

“There were two stent thromboses that we considered early and definite,” Červinka said. “There were no differences overall at 9-month follow-up, but the cohort of patients was small.”

Binary in-stent restenosis was 2% in the OCT group and 3% in the PCI-only group (P=NS). Other angiographic results indicated no difference between the two groups in terms of late lumen loss in-stent and in-segment, minimal in-stent and in-segment diameter and minimal lumen area and diameter.

“There were no statistically significant differences between the groups,” Červinka said of the majority of the 9-month angiographic outcomes. “However, there was some trend in favor of OCT-guided primary PCI regarding both late lumen loss in-stent and in-segment.”

He added that there was a smaller area of stenosis and trend toward fewer uncovered struts in the OCT-guided group at 9 months (see Table).

“When we looked at the absolute number of uncovered struts, the difference reached statistical significance,” Červinka said.

Baseline demographic and procedural characteristics were well balanced in both groups. More stents were used in the OCT group, which he suggested was likely based on the intraprocedural OCT findings. OCT was also associated with longer fluoroscopy times, and more than one-third of those in the OCT-guided group had a suboptimal result, Červinka said.

OCT STEMI is the first prospective, randomized, multicenter study to examine the utility of routine OCT guidance in primary PCI. This study was part of the ROBUST trial. 

 Disclosures:

• Červinka reports no relevant financial disclosures.