TY - JOUR
T1 - OCT or Angiography Guidance for PCI in Complex Bifurcation Lesions
AU - Holm, Niels R.
AU - Andreasen, Lene N.
AU - Neghabat, Omeed
AU - Laanmets, Peep
AU - Kumsars, Indulis
AU - Bennett, Johan
AU - Olsen, Niels T.
AU - Odenstedt, Jacob
AU - Hoffmann, Pavel
AU - Dens, Jo
AU - Chowdhary, Saqib
AU - O'Kane, Peter
AU - Bülow Rasmussen, Søren-Haldur
AU - Heigert, Matthias
AU - Havndrup, Ole
AU - Van Kuijk, Jan P.
AU - Biscaglia, Simone
AU - Mogensen, Lone J. H.
AU - Henareh, Loghman
AU - Burzotta, Francesco
AU - Eek, Christian H.
AU - Mylotte, Darren
AU - Llinas, Miquel S.
AU - Koltowski, Lukasz
AU - Knaapen, Paul
AU - Calic, Slobodan
AU - Witt, Nils
AU - Santos-Pardo, Irene
AU - Watkins, Stuart
AU - Lønborg, Jacob
AU - Kristensen, Andreas T.
AU - Jensen, Lisette O.
AU - Calais, Fredrik
AU - Cockburn, James
AU - McNeice, Andrew
AU - Kajander, Olli A.
AU - Heestermans, Ton
AU - Kische, Stephan
AU - Eftekhari, Ashkan
AU - Spratt, James C,
AU - Christiansen, Evald H.
AU - OCTOBER Trial Group
N1 - Copyright © 2023 Massachusetts Medical Society.
PY - 2023/10/19
Y1 - 2023/10/19
N2 - Abstract Background Imaging-guided percutaneous coronary intervention (PCI) is associated with better clinical outcomes than angiography-guided PCI. Whether routine optical coherence tomography (OCT) guidance in PCI of lesions involving coronary-artery branch points (bifurcations) improves clinical outcomes as compared with angiographic guidance is uncertain. Methods We conducted a multicenter, randomized, open-label trial at 38 centers in Europe. Patients with a clinical indication for PCI and a complex bifurcation lesion identified by means of coronary angiography were randomly assigned in a 1:1 ratio to OCT-guided PCI or angiography-guided PCI. The primary end point was a composite of major adverse cardiac events (MACE), defined as death from a cardiac cause, target-lesion myocardial infarction, or ischemia-driven target-lesion revascularization at a median follow-up of 2 years. Results We assigned 1201 patients to OCT-guided PCI (600 patients) or angiography-guided PCI (601 patients). A total of 111 patients (18.5%) in the OCT-guided PCI group and 116 (19.3%) in the angiography-guided PCI group had a bifurcation lesion involving the left main coronary artery. At 2 years, a primary end-point event had occurred in 59 patients (10.1%) in the OCT-guided PCI group and in 83 patients (14.1%) in the angiography-guided PCI group (hazard ratio, 0.70; 95% confidence interval, 0.50 to 0.98; P=0.035). Procedure-related complications occurred in 41 patients (6.8%) in the OCT-guided PCI group and 34 patients (5.7%) in the angiography-guided PCI group. Conclusions Among patients with complex coronary-artery bifurcation lesions, OCT-guided PCI was associated with a lower incidence of MACE at 2 years than angiography-guided PCI. (Funded by Abbott Vascular and others; OCTOBER ClinicalTrials.gov number, NCT03171311.)
AB - Abstract Background Imaging-guided percutaneous coronary intervention (PCI) is associated with better clinical outcomes than angiography-guided PCI. Whether routine optical coherence tomography (OCT) guidance in PCI of lesions involving coronary-artery branch points (bifurcations) improves clinical outcomes as compared with angiographic guidance is uncertain. Methods We conducted a multicenter, randomized, open-label trial at 38 centers in Europe. Patients with a clinical indication for PCI and a complex bifurcation lesion identified by means of coronary angiography were randomly assigned in a 1:1 ratio to OCT-guided PCI or angiography-guided PCI. The primary end point was a composite of major adverse cardiac events (MACE), defined as death from a cardiac cause, target-lesion myocardial infarction, or ischemia-driven target-lesion revascularization at a median follow-up of 2 years. Results We assigned 1201 patients to OCT-guided PCI (600 patients) or angiography-guided PCI (601 patients). A total of 111 patients (18.5%) in the OCT-guided PCI group and 116 (19.3%) in the angiography-guided PCI group had a bifurcation lesion involving the left main coronary artery. At 2 years, a primary end-point event had occurred in 59 patients (10.1%) in the OCT-guided PCI group and in 83 patients (14.1%) in the angiography-guided PCI group (hazard ratio, 0.70; 95% confidence interval, 0.50 to 0.98; P=0.035). Procedure-related complications occurred in 41 patients (6.8%) in the OCT-guided PCI group and 34 patients (5.7%) in the angiography-guided PCI group. Conclusions Among patients with complex coronary-artery bifurcation lesions, OCT-guided PCI was associated with a lower incidence of MACE at 2 years than angiography-guided PCI. (Funded by Abbott Vascular and others; OCTOBER ClinicalTrials.gov number, NCT03171311.)
KW - Coronary Angiography
KW - Coronary Angiography/adverse effects
KW - Coronary Artery Disease/diagnostic imaging
KW - Europe
KW - Humans
KW - Percutaneous Coronary Intervention/adverse effects
KW - Tomography, Optical Coherence/adverse effects
KW - Tomography, Optical Coherence/methods
KW - Treatment Outcome
KW - Coronary Disease/Myocardial Infarction
KW - Cardiology General
KW - Cardiology
UR - http://www.scopus.com/inward/record.url?scp=85175119309&partnerID=8YFLogxK
U2 - 10.1056/NEJMoa2307770
DO - 10.1056/NEJMoa2307770
M3 - Journal article
C2 - 37634149
SN - 0028-4793
VL - 389
SP - 1477
EP - 1487
JO - The New England Journal of Medicine
JF - The New England Journal of Medicine
IS - 16
ER -