Kadavil Rony Mathew, Abdullakutty Jabir, Patel Tejas, Rathnavel Sivakumar, Singh Balbir, Chouhan Nagendra Singh, Malik Fazila Tun Nesa, Hiremath Shirish, Gunasekaran Sengottuvelu, Kalarickal Samuel Mathew, Kumar Viveka, Subban Vijayakumar
Lisie Heart Institute, Lisie Hospital, Ernakulum, India.
APEX Heart Institute, Ahmedabad, India.
AsiaIntervention. 2023 Sep 21;9(2):124-132. doi: 10.4244/AIJ-D-22-00064. eCollection 2023 Sep.
The use of optical coherence tomography (OCT) with angiographic coregistration (ACR) during percutaneous coronary intervention (PCI) for procedural decision-making is evolving; however, large-scale data in real-world practice are lacking.
Our study aims to evaluate the real-time impact of OCT-ACR on clinician decision-making during PCI.
Patients with angiographic diameter stenosis >70% in at least one native coronary artery were enrolled in the study. The pre- and post-PCI procedural strategies were prospectively assessed after angiography, OCT, and ACR.
A total of 500 patients were enrolled in the study between November 2018 and March 2020. Among these, data related to 472 patients with 483 lesions were considered for analysis. Preprocedural OCT resulted in a change in PCI strategy in 80% of lesions: lesion preparation (25%), stent length (53%), stent diameter (36%), and device landing zone (61%). ACR additionally impacted the treatment strategy in 34% of lesions. Postprocedural OCT demonstrated underexpansion (15%), malapposition (14%), and tissue/thrombus prolapse (7%), thereby requiring further interventions in 30% of lesions. No further change in strategy was observed with subsequent postprocedural ACR. Angiographic and procedural success was achieved in 100% of patients, and the overall incidence of major adverse cardiovascular events at 1 year was 0.85%.
The outcomes reflect the real-time impact of OCT-ACR on the overall procedural strategy in patients undergoing PCI. ACR had a significant impact on the treatment strategy and was associated with better clinical outcomes at 1 year after index PCI. OCT-ACR has become a practical tool for improving outcomes in patients with complex lesions.
在经皮冠状动脉介入治疗（PCI）过程中，使用光学相干断层扫描（OCT）与血管造影共配准（ACR）来进行手术决策的应用正在不断发展；然而，缺乏真实世界实践中的大规模数据。
我们的研究旨在评估OCT-ACR对PCI期间临床医生决策的实时影响。
至少一条自身冠状动脉造影直径狭窄>70%的患者被纳入研究。在血管造影、OCT和ACR后，前瞻性评估PCI术前和术后的手术策略。
2018年11月至2020年3月期间，共有500例患者被纳入研究。其中，对472例患者的483处病变的数据进行了分析。术前OCT导致80%的病变PCI策略发生改变：病变预处理（25%）、支架长度（53%）、支架直径（36%）和器械着陆区（61%）。ACR在另外34%的病变中影响了治疗策略。术后OCT显示扩张不足（15%）、贴壁不良（14%）和组织/血栓脱垂（7%），因此30%的病变需要进一步干预。术后ACR未观察到策略的进一步改变。所有患者均实现了血管造影和手术成功，1年时主要不良心血管事件的总体发生率为0.85%。
结果反映了OCT-ACR对接受PCI患者的总体手术策略的实时影响。ACR对治疗策略有显著影响，并且与PCI术后1年更好的临床结果相关。OCT-ACR已成为改善复杂病变患者预后的实用工具。
