Medical School of Chinese PLA Beijing China.
Senior Department of Cardiology Sixth Medical Center of Chinese PLA General Hospital Beijing China.
J Am Heart Assoc. 2024 Nov 5;13(21):e033954. doi: 10.1161/JAHA.123.033954. Epub 2024 Nov 4.
The evidence for optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) in improving the prognosis of individuals with in-stent restenosis (ISR) is lacking.
This retrospective study enrolled 588 consecutive individuals with drug-eluting stent ISR undergoing PCI from March 2010 to March 2022. Two hundred seven (35.2%) underwent OCT guidance, and 381 (64.8%) underwent angiography guidance. Clinical outcomes were analyzed using survival curves. The primary clinical endpoint was 2-year major adverse cardiovascular events (MACEs), a composite of all-cause death, myocardial infarction, and target-vessel revascularization. Compared with angiography guidance, OCT guidance demonstrated a higher frequency of drug-coated balloon use and adjunctive therapeutic modalities, including predilation, postdilation, nonslip element balloons, and noncompliant balloons (<0.05). Following PCI, the OCT-guided group achieved a significantly larger minimum lumen diameter (2.36 versus 2.15 mm, <0.001) and a lower percentage diameter stenosis (17% versus 20%, <0.001) than the angiography-guided group. Survival analysis revealed significantly lower 2-year MACEs in the OCT-guided group compared with the angiography-guided group (7% versus 15%, =0.007), validated in the propensity matching analysis (7% versus 15%, =0.001). Multiple sensitivity analyses showed that OCT-guided PCI treatment was an independent protective factor for 2-year MACEs in individuals with drug-eluting stent ISR.
Compared with angiography guidance, OCT guidance is associated with a lower 2-year MACE risk among individuals with drug-eluting stent ISR. Therefore, OCT should be actively considered for guiding PCI treatment in individuals with drug-eluting stent ISR.
Url: clinicaltrials.gov. Identifier: NCT03809754.
光学相干断层扫描（OCT）指导下的经皮冠状动脉介入治疗（PCI）在改善支架内再狭窄（ISR）患者预后方面的证据不足。
本回顾性研究纳入了 2010 年 3 月至 2022 年 3 月期间接受 PCI 治疗的 588 例药物洗脱支架 ISR 连续患者。其中 207 例（35.2%）接受了 OCT 指导，381 例（64.8%）接受了血管造影指导。使用生存曲线分析临床结局。主要临床终点为 2 年主要不良心血管事件（MACE），包括全因死亡、心肌梗死和靶血管血运重建的复合终点。与血管造影指导相比，OCT 指导下药物涂层球囊使用率和辅助治疗方式（包括预扩张、后扩张、非滑元件球囊和顺应性球囊）更高（<0.05）。PCI 后，OCT 指导组的最小管腔直径明显大于血管造影指导组（2.36 毫米对 2.15 毫米，<0.001），直径狭窄率明显低于血管造影指导组（17%对 20%，<0.001）。生存分析显示，OCT 指导组 2 年 MACE 发生率明显低于血管造影指导组（7%对 15%，=0.007），在倾向评分匹配分析中也得到验证（7%对 15%，=0.001）。多项敏感性分析显示，OCT 指导下的 PCI 治疗是药物洗脱支架 ISR 患者 2 年 MACE 的独立保护因素。
与血管造影指导相比，OCT 指导与药物洗脱支架 ISR 患者 2 年 MACE 风险降低相关。因此，OCT 应积极考虑用于指导药物洗脱支架 ISR 患者的 PCI 治疗。
网址：clinicaltrials.gov。标识符：NCT03809754。
