Appropriate use criteria for optical coherence tomography guidance in percutaneous coronary interventions : Recommendations of the working group of interventional cardiology of the Netherlands Society of Cardiology

Abstract

Introduction: Optical coherence tomography (OCT) enables detailed imaging of the coronary wall, lumen and intracoronary implanted devices. Responding to the lack of specific appropriate use criteria (AUC) for this technique, we conducted a literature review and a procedure for appropriate use criteria.

Methods: Twenty-one of all 184 members of the Dutch Working Group on Interventional Cardiology agreed to evaluate 49 pre-specified cases. During a meeting, factual indications were established whereupon members individually rated indications on a 9-point scale, with the opportunity to substantiate their scoring.

Results: Twenty-six indications were rated 'Appropriate', eighteen indications 'May be appropriate', and five 'Rarely appropriate'. Use of OCT was unanimously considered 'Appropriate' in stent thrombosis, and 'Appropriate' for guidance in PCI, especially in distal left main coronary artery and proximal left anterior descending coronary artery, unexplained angiographic abnormalities, and use of bioresorbable vascular scaffold (BVS). OCT was considered 'Rarely Appropriate' on top of fractional flow reserve (FFR) for treatment indication, assessment of strut coverage, bypass anastomoses or assessment of proximal left main coronary artery.

Conclusions: The use of OCT in stent thrombosis is unanimously considered 'Appropriate' by these experts. Varying degrees of consensus exists on the appropriate use of OCT in other settings.

Keywords: Coronary artery disease; OCT; PCI.

Fig. 1

OCT appropriate use criteria scores for evaluation of stent thrombosis. On each box, the central mark indicates the median, and the bottom and top edges of the box indicate the 25th and 75th percentiles, respectively. The whiskers extend to the most extreme data points not considered outliers, and the outliers are plotted individually as a red dot. The grey dots represent the individual scores of the panellists. The whiskers alongside the boxplot show the mean and standard deviation (SD). Case 1: Identification of stent thrombosis mechanism in a haemodynamically stable STEMI patient (Appropriate, Mean = 8; SD ± 0.68). Case 2: Re-evaluation with OCT after STEMI of a hazy non-culprit lesion which was initially treated conservatively (May be appropriate, Mean = 6; SD ± 1.94). Case 3: Evaluation of mechanism in recurrent STEMI due to stent thrombosis in the proximal LAD (Appropriate, Mean = 9; SD ± 0.69). (LAD left anterior descending coronary artery, OCT optical coherence tomography, SD standard deviation, STEMI ST-elevation myocardial infarction)