Prior studies have shown the use of optical coherence tomography (OCT) have a significant influence on decision making, optimizing PCI and improving outcomes, vs conventional PCI. However, these studies have focused mainly on patients with stable angina or non-ST elevation MI.
The aim of this retrospective study was to find out whether the use of OCT can reduce mortality at long term (5 years) vs. PCI alone in patients with ST elevation MI (STEMI).
Primary end point was all-cause mortality rate, and secondary end point was cardiovascular mortality rate.
3,897 were enrolled: 69.2% were treated with OCT and 30.8% with PCI alone. Mean patient age was approximately 60, and most patients were men. Among OCT patients, the most affected artery was the anterior descending, while in the PCI alone group, it was the right coronary.
OCT guided patients were treated with stents less frequently during PCI (62.6% vs 80.2%; p<0.001). At 5 years, accumulated all-cause mortality and cardiovascular rates in the OCT guided cohort were 10.4% and 8.0%, respectively, significantly lower than the PCI alone cohort (19.0% and 14.1%; p<0.001).
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Multivariable models showed the use of OCT might significantly reduce all-cause mortality at 5 years (HR: 0.689, CI 95%: 0.551-0.862) and cardiovascular mortality (HR: 0.692, IC 95%: 0.536-0.895). After propensity score matching for homogenous samples, the benefits of OCT guided PCI remained consistent in terms of all-cause (HR: 0.707, CI 95%: 0.548-0.913) and cardiovascular mortality (HR: 0.709, CI 95%: 0.526-0.955).
Conclusion
In this observational study, the use of OCT during PCI in patients with STEMI was associated to reduced mortality at long term vs. PCI alone. However, we need prospective randomized studies to confirm these results.
Original Title: Five-year follow-up of OCT-guided percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction.
Reference: Luping He, MD et al EuroIntervention 2024;20:e937-e947.
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