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. 2024 Jan 23;83(3):401-413.
doi: 10.1016/j.jacc.2023.10.017. Epub 2023 Oct 23.

Guiding Intervention for Complex Coronary Lesions by Optical Coherence Tomography or Intravascular Ultrasound

Do-Yoon Kang  1 , Jung-Min Ahn  1 , Sung-Cheol Yun  2 , Seung-Ho Hur  3 , Yun-Kyeong Cho  3 , Cheol Hyun Lee  3 , Soon Jun Hong  4 , Subin Lim  4 , Sang-Wook Kim  5 , Hoyoun Won  6 , Jun-Hyok Oh  7 , Jeong Cheon Choe  7 , Young Joon Hong  8 , Yong-Hoon Yoon  9 , Hoyun Kim  1 , Yeonwoo Choi  1 , Jinho Lee  1 , Young Won Yoon  10 , Soo-Joong Kim  11 , Jang-Ho Bae  12 , Seung-Jung Park  1 , Duk-Woo Park  13 ; OCTIVUS Investigators
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Free article

Guiding Intervention for Complex Coronary Lesions by Optical Coherence Tomography or Intravascular Ultrasound

Do-Yoon Kang et al. J Am Coll Cardiol. .
Free article

Abstract

Background: Optical coherence tomography (OCT) and intravascular ultrasound (IVUS) have shown comparable outcomes in guiding percutaneous coronary intervention (PCI). However, their comparative effectiveness in complex coronary artery lesions remains unclear.

Objectives: This study compared the effectiveness and safety of OCT-guided vs IVUS-guided PCI for complex coronary artery lesions.

Methods: This was a prespecified, main subgroup analysis of complex coronary artery lesions in the OCTIVUS (Optical Coherence Tomography Versus Intravascular Ultrasound Guided Percutaneous Coronary Intervention) trial, which included unprotected left main disease, bifurcation disease, an aorto-ostial lesion, a chronic total occlusion, a severely calcified lesion, an in-stent restenotic lesion, a diffuse long lesion, or multivessel PCI. The primary endpoint was a composite of death from cardiac causes, target vessel-related myocardial infarction, or ischemia-driven target vessel revascularization.

Results: In 2,008 randomized patients, 1,475 (73.5%) underwent imaging-guided PCI for complex coronary artery lesions; 719 (48.7%) received OCT-guided and 756 (51.3%) IVUS-guided PCI. At a median follow-up of 2.0 years, primary endpoint event had occurred in 47 patients (6.5%) in the OCT-guided group and in 56 patients (7.4%) in the IVUS-guided group (HR: 0.87; 95% CI: 0.59-1.29; P = 0.50). These findings were consistent in adjusted analyses. The incidence of contrast-induced nephropathy was similar between the 2 groups (1.9% vs 1.5%; P = 0.46). The incidence of major procedural complications was lower in the OCT-guided group than in the IVUS-guided group (1.7% vs 3.4%; P = 0.03).

Conclusions: Among patients with complex coronary artery lesions, OCT-guided PCI showed a similar risk of primary composite event of death from cardiac causes, target vessel-related myocardial infarction, or target vessel revascularization as compared with IVUS-guided PCI. (Optical Coherence Tomography Versus Intravascular Ultrasound Guided Percutaneous Coronary Intervention [OCTIVUS]; NCT03394079).

Keywords: intracoronary imaging; intravascular ultrasound; optical coherent tomography; percutaneous coronary intervention.

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Conflict of interest statement

Funding Support and Author Disclosures This study was an investigator-initiated trial and was funded by the CardioVascular Research Foundation, Abbott Vascular, and Medtronic. The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Dr S.-J. Park has received research grants or speaker fees from Abbott Vascular, Medtronic, Daiichi-Sankyo, ChongKunDang Pharm, Daewoong Pharm, and Edwards. Dr D.-W. Park has received research grants or speaker fees from Abbott Vascular, Medtronic, and Daiichi-Sankyo; and has received grants from ChongKunDang Pharm and Daewoong Pharm. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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