The OCTOBER Study randomized 1201 patients with bifurcation lesions in a 1:1 ratio to undergo percutaneous transluminal coronary angioplasty (PTCA) guided by optical coherence tomography (OCT) or by angiography.
The primary endpoint (PEP) was major adverse cardiovascular events (MACE) over a 2-year period.
Group characteristics were similar. The average patient age was 66 years, most patients were men, and 16% of subjects had diabetes. Of note, 64% of participants in both groups received two stents. Nearly 20% of patients in both groups underwent bifurcation percutaneous coronary intervention (PCI) in the left main coronary artery (LMCA).
The PEP favored patients who underwent OCT, with a MACE rate of 10.1%, compared with 14.1% in the angiography-guided group (hazard ratio, 0.70; 95% confidence interval [CI], 0.50 to 0.98; p-value = 0.035). There were no differences in all-cause mortality, cardiovascular mortality, or myocardial infarction related to the culprit vessel, although, numerically, the rate was lower in the OCT-guided group. The incidence of stent thrombosis was 2.1% in the OCT-guided group and 3% in the angiography-guided group (hazard ratio, 0.70; 95% CI, 0.34–1.47).
Read also: ESC 2023 | ILUMIEN IV: What Is the Benefit of OCT?
In summary, the authors concluded that, in the context of bifurcation lesions, OCT-guided interventions led to better outcomes at the two-year follow-up, with a reduction in major adverse cardiovascular events compared with conventional angiography.
Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.
Source: Presented by Niels Ramsing Holm during the ESC 2023 Sessions
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