Impact of Intracoronary Optical Coherence Tomography in Routine Clinical Practice: A Contemporary Cohort Study.
Acute coronary syndrome
Coronary artery disease
OCT-guided PCI
Optical coherence tomography
Stent failure assessment
Journal
Cardiovascular revascularization medicine : including molecular interventions
ISSN: 1878-0938
Titre abrégé: Cardiovasc Revasc Med
Pays: United States
ID NLM: 101238551
Informations de publication
Date de publication:
05 2022
05 2022
Historique:
received:
15
06
2021
revised:
21
07
2021
accepted:
22
07
2021
pubmed:
4
8
2021
medline:
12
5
2022
entrez:
3
8
2021
Statut:
ppublish
Résumé
Guidelines recommend intracoronary optical coherence tomography (OCT) to assess stent failure and guide percutaneous coronary intervention (PCI) but OCT may be useful for other indications in routine clinical practice. We conducted an international registry of OCT cases at two large tertiary care centers to assess clinical indications and the potential impact on decision making of OCT in clinical routine. Clinical indications, OCT findings, and their impact on interventional or medical treatment strategy were retrospectively assessed. OCT was performed in 810 coronary angiography cases (1928 OCT-pullbacks). OCT was used for diagnostic purposes in 67% (N = 542) and OCT-guided percutaneous coronary intervention in 50% (N = 404, 136 cases with prior diagnostic indication). Most frequent indications for diagnostic OCT were culprit lesion identification in suspected ACS (29%) and stent failure assessment (28%). OCT findings in the diagnostic setting influenced patient management in 74%. OCT-guided PCIs concerned ACS patients in 45%. Among the 55% with chronic coronary syndrome, long lesions >28 mm (19%), left main PCI (16%), and bifurcation PCI with side-branch-stenting (5%) were the leading indications for PCI-guidance. Post-procedural OCT findings led to corrective measures in 52% (26% malapposition, 14% underexpansion, 6% edge dissection, 3% intrastent mass, 3% geographic plaque miss). OCT was most frequently performed to identify culprit lesions in suspected ACS, for stent failure assessment, and PCI-guidance. OCT may impact subsequent treatment strategies in two out of three patients.
Sections du résumé
BACKGROUND/PURPOSE
Guidelines recommend intracoronary optical coherence tomography (OCT) to assess stent failure and guide percutaneous coronary intervention (PCI) but OCT may be useful for other indications in routine clinical practice.
METHODS/MATERIALS
We conducted an international registry of OCT cases at two large tertiary care centers to assess clinical indications and the potential impact on decision making of OCT in clinical routine. Clinical indications, OCT findings, and their impact on interventional or medical treatment strategy were retrospectively assessed.
RESULTS
OCT was performed in 810 coronary angiography cases (1928 OCT-pullbacks). OCT was used for diagnostic purposes in 67% (N = 542) and OCT-guided percutaneous coronary intervention in 50% (N = 404, 136 cases with prior diagnostic indication). Most frequent indications for diagnostic OCT were culprit lesion identification in suspected ACS (29%) and stent failure assessment (28%). OCT findings in the diagnostic setting influenced patient management in 74%. OCT-guided PCIs concerned ACS patients in 45%. Among the 55% with chronic coronary syndrome, long lesions >28 mm (19%), left main PCI (16%), and bifurcation PCI with side-branch-stenting (5%) were the leading indications for PCI-guidance. Post-procedural OCT findings led to corrective measures in 52% (26% malapposition, 14% underexpansion, 6% edge dissection, 3% intrastent mass, 3% geographic plaque miss).
CONCLUSIONS
OCT was most frequently performed to identify culprit lesions in suspected ACS, for stent failure assessment, and PCI-guidance. OCT may impact subsequent treatment strategies in two out of three patients.
Identifiants
pubmed: 34340915
pii: S1553-8389(21)00559-5
doi: 10.1016/j.carrev.2021.07.024
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
96-103Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest JH received a travel-grant from Bayer. GCMS reported receiving honoraria from Abbott outside the submitted work. SB reports a research grant to the institution from Medis Medical Imaging Systems. SS has received research grants to the institution from Edwards Lifesciences, Medtronic, Abbott Vascular and Boston Scientific, serves as consultant for BTG and Teleflex and has received speaker fees from BTG and Boston Scientific. PM serves as consultant for St Jude Medical / Abbott and Terumo. SW reports research and educational grants to the institution from Abbott, Amgen, Bayer, BMS, Boston Scientific, Biotronik, Cardinal Health, CSL Behring, Daiichi Sankyo, Edwards Lifesciences, Guerbet AG, Johnson&Johnson, Medtronic, Sanofi-Aventis, and Terumo. SW serves as unpaid member of the steering/executive group of trials funded by Abbott, Abiomed, Amgen, BMS, Boston Scientific, Biotronik, Cardiovalve, Edwards Lifesciences, MedAlliance, Medtronic, Polares, Sinomed, V-Wave, and Xeltis, but has not received personal payments by any pharmaceutical company or device manufacturer. SW is member of the steering/executive committee group of several investigated-initiated trials that receive funding by industry without impact on his personal remuneration. GS serves as consultant for St Jude Medical / Abbott and Terumo. LR received research grants to the institution by Abbott, Biotronik, BostonScientific, Medis, Infraredx, Sanofi, Regeneron and consultation/speaker fees by Abbott, Amgen, AstraZeneca, Canon, Sanofi, Vifor. All other author have nothing to disclose.