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Kala P, Cervinka P, Jakl M, Kanovsky J, Kupec A, Spacek R, Kvasnak M, Poloczek M, Cervinkova M, Bezerra H, Valenta Z, Attizzani GF, Schnell A, Hong L, Costa MA. OCT guidance during stent implantation in primary PCI: A randomized multicenter study with nine months of optical coherence tomography follow-up. Int J Cardiol 2017; 250:98-103. [PMID: 29079414 DOI: 10.1016/j.ijcard.2017.10.059] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 10/11/2017] [Accepted: 10/17/2017] [Indexed: 11/17/2022]
Abstract
AIMS To assess the possible merits of optical coherence tomography (OCT) guidance in primary percutaneous coronary intervention (pPCI). METHODS AND RESULTS 201 patients with ST-elevation myocardial infarction (STEMI) were enrolled in this study. Patients were randomized either to pPCI alone (angio-guided group, n=96) or to pPCI with OCT guidance (OCT-guided group, n=105) and also either to biolimus A9 or to everolimus-eluting stent implantation. All patients were scheduled for nine months of follow-up angiography and OCT study. OCT guidance led to post-pPCI optimization in 29% of cases (59% malapposition and 41% dissections). No complications were found related to the OCT study. OCT analysis at nine months showed significantly less in-segment area of stenosis (6% [-11, 19] versus 18% [3, 33]; p=0.0002) in favor of the OCT-guided group. The rate major adverse cardiovascular events were comparable at nine months in both groups (3% in the OCT group versus 2% in the angio-guided group; p=0.87). CONCLUSIONS This study demonstrates the safety of OCT guidance during pPCI. The use of OCT optimized stent deployment in 1/3 of patients in this clinical scenario and significantly reduced in-segment area of stenosis at nine months of follow-up. Whether such improvements in OCT endpoints will have a positive impact on late clinical outcomes, they demand both a larger and longer-term follow-up study.
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Affiliation(s)
- Petr Kala
- Department of Cardiology and Internal Medicine, University Hospital Brno, Brno, Czech Republic; Medical Faculty of Masaryk University, Brno, Czech Republic
| | - Pavel Cervinka
- Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital, UJEP Usti nad Labem, Usti nad Labem, Czech Republic.
| | - Martin Jakl
- First Department of Cardio-Angiology and Internal Medicine, Faculty Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jan Kanovsky
- Department of Cardiology and Internal Medicine, University Hospital Brno, Brno, Czech Republic; Medical Faculty of Masaryk University, Brno, Czech Republic
| | - Andrej Kupec
- Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital, UJEP Usti nad Labem, Usti nad Labem, Czech Republic
| | - Radim Spacek
- Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital, UJEP Usti nad Labem, Usti nad Labem, Czech Republic
| | - Martin Kvasnak
- Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital, UJEP Usti nad Labem, Usti nad Labem, Czech Republic
| | - Martin Poloczek
- Department of Cardiology and Internal Medicine, University Hospital Brno, Brno, Czech Republic
| | - Michaela Cervinkova
- Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital, UJEP Usti nad Labem, Usti nad Labem, Czech Republic; First Department of Cardio-Angiology and Internal Medicine, Faculty Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Hiram Bezerra
- Harrington Heart &Vascular Institute, University Hospitals Case Medical Center, Cleveland, USA
| | - Zdenek Valenta
- Institute of Computer Science, Department of Statistical Medelling, Czech Academy of Sciences, Prague, Czech Republic
| | - Guilherme F Attizzani
- Harrington Heart &Vascular Institute, University Hospitals Case Medical Center, Cleveland, USA
| | - Audrey Schnell
- Harrington Heart &Vascular Institute, University Hospitals Case Medical Center, Cleveland, USA
| | - Lu Hong
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Marco A Costa
- Harrington Heart &Vascular Institute, University Hospitals Case Medical Center, Cleveland, USA
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