Wakabayashi Kohei, Yonetsu Taishi, Mizukami Takuya, Yamamoto Myong Hwa, Yasuhara Sakiko, Shishido Koki, Saito Shigeru, Kobayashi Nobuaki, Takano Masamichi, Usui Eisuke, Kakuta Tsunekazu, Oishi Yosuke, Kondo Seita, Nishikura Tenjin, Minami Yoshiyasu, Ako Junya, Okabe Toshitaka, Naganuma Toru, Mitomo Satoru, Nakamura Sunao, Higuma Takumi, Shite Junya, Kozuki Amane, Suwa Satoru, Kume Teruyoshi, Uemura Shiro, Naruse Genki, Okura Hiroyuki, Yamakami Yosuke, Fujii Hiroyuki, Kimura Shigeki, Iwasaki Masamichi, Araki Makoto, Sugiyama Tomoyo, Nanasato Mamoru, Dohi Tomotaka, Ashikaga Takashi, Mori Hiroyoshi, Sekimoto Teruo, Sugizaki Yoichiro, Otake Hiromasa, Shinke Toshiro
Division of Cardiology, Cardiovascular Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan.
Department of Cardiovascular Medicine, Institute of Science Tokyo, Tokyo, Japan.
Cardiovasc Interv Ther. 2025 Jul;40(3):576-587. doi: 10.1007/s12928-025-01137-2. Epub 2025 May 30.
Intravascular imaging for acute coronary syndrome is recommended in the guidelines; however, the actual rate of patients with ST-segment elevation myocardial infarction (STEMI) who successfully undergo optical coherence tomography (OCT)-guided primary percutaneous coronary intervention (PCI) is unclear. This study aimed to determine the feasibility of OCT-guided primary PCI and identify the patient population that would benefit most from OCT guidance in STEMI. The ATLAS-OCT trial was a prospective, single-arm, all-comers study conducted at 16 institutions. The primary endpoint was the feasibility of OCT guidance for primary PCI, defined as successful image acquisition (vessel's circumferential or > 270° visualization along > 70% of the lesion's length, as evaluated by an independent core laboratory). A total of 632 patients (mean age: 68.4 years; 80.2% male) were enrolled in the study. OCT-guided PCI was performed in 503 patients, whereas OCT guidance was avoided in 129 patients for patient's condition. Successful image acquisition was achieved in all but seven patients who underwent OCT. The primary endpoint was achieved in 78.5% (496/632) of patients. No procedural complications were associated with OCT. Patients with left main disease (adjusted odds ratio, 4.1; 95% confidence interval, 1.2-14.7; p = 0.024), estimated glomerular filtration rate (mL/min/1.73 m) < 30 (3.7; 1.6-8.3; p = 0.002), and Killip IV (2.5; 1.3-4.6; p = 0.003) were significantly avoided for OCT guidance. OCT guidance was feasible in four-fifths of all-comers with STEMI. Further studies are warranted to evaluate the efficacy of OCT-guided PCI in selected patient populations based on the findings of this trial (UMIN000048590).
指南推荐对急性冠状动脉综合征进行血管内成像；然而，成功接受光学相干断层扫描（OCT）引导下的ST段抬高型心肌梗死（STEMI）患者的实际比例尚不清楚。本研究旨在确定OCT引导下直接经皮冠状动脉介入治疗（PCI）的可行性，并确定在STEMI中最能从OCT引导中获益的患者群体。ATLAS - OCT试验是一项在16个机构进行的前瞻性、单臂、纳入所有患者的研究。主要终点是OCT引导下直接PCI的可行性，定义为成功采集图像（由独立核心实验室评估，血管圆周或病变长度的70%以上实现>270°可视化）。共有632例患者（平均年龄：68.4岁；80.2%为男性）纳入研究。503例患者接受了OCT引导下的PCI，而129例患者因病情未接受OCT引导。除7例接受OCT的患者外，其余患者均成功采集了图像。78.5%（496/632）的患者达到了主要终点。未发现与OCT相关的手术并发症。左主干病变患者（调整优势比，4.1；95%置信区间，1.2 - 14.7；p = 0.024）、估计肾小球滤过率（mL/min/1.73 m²）<30（3.7；1.6 - 8.3；p = 0.002）以及Killip IV级患者（2.5；1.3 - 4.6；p = 0.003）显著避免接受OCT引导。对于五分之四的STEMI患者，OCT引导是可行的。基于本试验的结果（UMIN000048590），有必要进行进一步研究以评估OCT引导下PCI在特定患者群体中的疗效。
