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. 2025 Jul 12.
doi: 10.1253/circj.CJ-25-0154. Online ahead of print.

Clinical Impact of Optical Coherence Tomography-Guided Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction - A Substudy of the TACTICS Registry

Naoki Matsukawa  1   2 , Myong Hwa Yamamoto  3 , Takuya Mizukami  4 , Seita Kondo  5 , Nobuaki Kobayashi  6 , Masamichi Takano  6 , Tomoyo Sugiyama  7 , Tsunekazu Kakuta  8 , Kohei Wakabayashi  9 , Satoru Suwa  10 , Tomotaka Dohi  11 , Hiroyoshi Mori  12 , Shigeki Kimura  13 , Satoru Mitomo  14 , Sunao Nakamura  14 , Takumi Higuma  15 , Junichi Yamaguchi  16 , Taishi Yonetsu  7 , Makoto Natsumeda  17 , Yuji Ikari  17 , Jun Yamashita  18 , Takaaki Matsuyama  1 , Toshiro Shinke  5 ; TACTICS Investigators
Affiliations
Free article

Clinical Impact of Optical Coherence Tomography-Guided Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction - A Substudy of the TACTICS Registry

Naoki Matsukawa et al. Circ J. .
Free article

Abstract

Background: Optical coherence tomography (OCT) has the potential to reduce clinical events more effectively than angiography alone, but its penetration rate, clinical utility, and clinical impacts in ST-elevation myocardial infarction (STEMI) remain unknown. We aimed to clarify the relationship between OCT-defined morphology, acute results of primary percutaneous coronary intervention (PCI), and clinical outcomes at 1 year in patients with STEMI.

Methods and results: This post hoc analysis of the TACTICS registry investigated patients with STEMI who underwent OCT-guided primary PCI. Major adverse cardiovascular events (MACE) were defined as a composite of cardiovascular death, myocardial infarction, heart failure, or ischemia-driven revascularization. Of 1,046 patients with STEMI, 441 (42.2%) underwent OCT-guided PCI. The prevalence of plaque rupture (PR), plaque erosion (PE), and calcified nodule (CN) was 299 (68.3%), 106 (24.2%), and 16 (3.7%), respectively. The cumulative MACE rate was highest in patients with CN (31.2%), followed by those with PR (14.0%) and PE (2.8%; log-rank P<0.0001). Multivariate Cox regression analysis identified CN as the strongest independent predictor of MACE at 1 year (hazard ratio [HR] 8.25; 95% confidence interval [CI] 1.70-40.10; P=0.009), followed by PR (HR 4.82; 95% CI 1.48-15.68; P=0.009).

Conclusions: OCT-guided PCI was performed with a high penetration rate of approximately 40% in patients with STEMI. Lesion morphology may serve as a key predictor of future cardiovascular events.

Keywords: Optical coherence tomography; Percutaneous coronary intervention; ST-segment elevation myocardial infarction.

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