OCT-Guided PCI Improves 1-Year Outcomes vs. Angiography Alone

PARIS, France—Using optical coherence tomography (OCT) to guide routine percutaneous coronary intervention (PCI) reveals procedural issues not caught by angiography alone, leading to corrective intervention in up to one-third of cases and better outcomes. Results of the CLI-OPCI registry study were presented May 16 at EuroPCR 2012.

Francesco Prati, MD, of San Giovanni Hospital (Rome, Italy), and colleagues looked at 335 consecutive patients undergoing PCI at 3 high-OCT-volume Italian centers between 2009 and 2011. Patients were matched with 335 randomly selected subjects undergoing PCI during the same month with only angiographic guidance.

Patients in the angiography group were older and more likely to present with STEMI and type B2/C lesions, and they were less likely to receive DES. Patients in the OCT group had more dyslipidemia, multivessel disease, and longer stent length.

Picking Up What Angiography Misses

OCT was only used after an optimal angiographic result based on the operator’s judgment and did not lead to any major complications. Meanwhile, OCT disclosed numerous issues missed on angiography:

• Malapposition, 29.7%
• Thrombus, 22.0%
• Edge dissection, 14.2%
• Stent underexpansion, 11.4%
• Reference lumen narrowing, 2.8%

These findings led to additional interventions in 34.7% of cases. Further actions included additional stent implantation for edge dissection and further dilation of the previously implanted stent for malapposition, reference lumen narrowing, stent underexpansion, or thrombus.

In-hospital events were reduced in the OCT group, driven mainly be a decrease in cardiac death (0.6% vs. 0.9%; P = 0.01), while non-fatal MIs were also lower, but the difference was not significant (3.9% vs. 6.5%; P = 0.096).

At 1 year, however, the OCT group had superior outcomes for several hard endpoints including death and cardiac death (table 1).

Table 1. CLI-OPCI: One-year Outcomes

“In this retrospective study, OCT guidance on top of angiography was associated with significant clinical benefits,” Dr. Prati said, alluding specifically to the reduction in cardiac death or MI at 1 year, which he characterized as “surprising.”

“Pending further randomized trials,” he continued, “we recommend OCT guidance to improve PCI results for complex lesions, as well as cases in which angiographic findings are ambiguous or cannot exclude procedural issues.”

OCT Useful for ‘Everyday Work in the Cath Lab?’

Dr. Prati also stressed the absence of complications with OCT-guided PCI. “This is an important message, because when we do something new, we want to first of all prove the safety of such an approach,” he said.

Angiography is currently the gold standard for angioplasty, “even though everybody knows it provides only luminal information,” Dr. Prati said. “It obviously cannot show what is beneath the plaque.”

Due to OCT’s high resolution, he noted that “there is optimism regarding the possibility to provide additional important information that can facilitate the everyday work in the cath lab and further improve results.”

Session co-chair Philippe L'Allier, MD, of the Montreal Heart Institute, University of Montreal (Montreal, Canada), commented that he looks forward to publication of the CLI-OPCI findings, which he expects will represent “a hallmark,” and will spur randomized trials to validate the results.

Study Details

In the OCT arm, the imaging method was used to assess a single vessel in 79.4% of cases, 2 vessels in 19.4%, and 3 vessels in 1.2%.

Source:

Prati F. Angiography alone versus angiography plus optical coherence tomography to guide decision making during percutaneous coronary intervention: The CLI-OPCI study. Presented at: EuroPCR; May 16, 2012; Paris, France. 

Disclosures:

·        Dr. Prati reports receiving consulting fees/honoraria from St. Jude Medical.

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