Häner Jonas D, Duband Benjamin, Ueki Yasushi, Otsuka Tatsuhiko, Combaret Nicolas, Siontis George C M, Bär Sarah, Stortecky Stefan, Motreff Pascal, Losdat Sylvain, Windecker Stephan, Souteyrand Géraud, Räber Lorenz
Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
Cardiology Department, CHU Clermont-Ferrand, Institut Pascal UMR 6602 CNRS SIGMA UCA, Clermont-Ferrand, France.
Cardiovasc Revasc Med. 2022 May;38:96-103. doi: 10.1016/j.carrev.2021.07.024. Epub 2021 Jul 27.
BACKGROUND/PURPOSE: Guidelines recommend intracoronary optical coherence tomography (OCT) to assess stent failure and guide percutaneous coronary intervention (PCI) but OCT may be useful for other indications in routine clinical practice.
METHODS/MATERIALS: We conducted an international registry of OCT cases at two large tertiary care centers to assess clinical indications and the potential impact on decision making of OCT in clinical routine. Clinical indications, OCT findings, and their impact on interventional or medical treatment strategy were retrospectively assessed.
OCT was performed in 810 coronary angiography cases (1928 OCT-pullbacks). OCT was used for diagnostic purposes in 67% (N = 542) and OCT-guided percutaneous coronary intervention in 50% (N = 404, 136 cases with prior diagnostic indication). Most frequent indications for diagnostic OCT were culprit lesion identification in suspected ACS (29%) and stent failure assessment (28%). OCT findings in the diagnostic setting influenced patient management in 74%. OCT-guided PCIs concerned ACS patients in 45%. Among the 55% with chronic coronary syndrome, long lesions >28 mm (19%), left main PCI (16%), and bifurcation PCI with side-branch-stenting (5%) were the leading indications for PCI-guidance. Post-procedural OCT findings led to corrective measures in 52% (26% malapposition, 14% underexpansion, 6% edge dissection, 3% intrastent mass, 3% geographic plaque miss).
OCT was most frequently performed to identify culprit lesions in suspected ACS, for stent failure assessment, and PCI-guidance. OCT may impact subsequent treatment strategies in two out of three patients.
背景/目的：指南推荐使用冠状动脉内光学相干断层扫描（OCT）来评估支架故障并指导经皮冠状动脉介入治疗（PCI），但在常规临床实践中，OCT可能对其他适应症也有用。
方法/材料：我们在两家大型三级医疗中心进行了一项OCT病例的国际注册研究，以评估临床适应症以及OCT在临床常规中对决策的潜在影响。对临床适应症、OCT检查结果及其对介入或药物治疗策略的影响进行了回顾性评估。
在810例冠状动脉造影病例中进行了OCT检查（1928次OCT回撤）。67%（n = 542）的病例将OCT用于诊断目的，50%（n = 404，其中136例有先前的诊断指征）的病例将OCT用于指导经皮冠状动脉介入治疗。诊断性OCT最常见的适应症是在疑似急性冠状动脉综合征（ACS）中识别罪犯病变（29%）和评估支架故障（28%）。在诊断情况下，OCT检查结果影响了74%的患者管理。OCT指导的PCI涉及45%的ACS患者。在55%的慢性冠状动脉综合征患者中，长度>28 mm的长病变（19%）、左主干PCI（16%）和有边支支架置入的分叉PCI（5%）是PCI指导的主要适应症。术后OCT检查结果导致52%的病例采取了纠正措施（26%为贴壁不良，14%为扩张不足，6%为边缘夹层，3%为支架内肿物，3%为斑块遗漏）。
OCT最常用于在疑似ACS中识别罪犯病变、评估支架故障和指导PCI。三分之二的患者，OCT可能会影响后续的治疗策略。
