OCT or Angiography Guidance for PCI in Complex Bifurcation Lesions

被引：141

作者：

Holm, N. R. ^{[1
]}

Andreasen, L. N. ^{[1
]}

Neghabat, O. ^{[1
]}

Laanmets, P. ^{[7
]}

Kumsars, I ^{[8
]}

Bennett, J. ^{[9
]}

Olsen, N. T. ^{[2
]}

Odenstedt, J. ^{[11
]}

Hoffmann, P. ^{[15
,16
]}

Dens, J. ^{[10
]}

Chowdhary, S. ^{[20
]}

O'Kane, P. ^{[21
]}

Rasmussen, S-H Bulow ^{[1
]}

Heigert, M. ^{[17
]}

Havndrup, O. ^{[3
]}

Van Kuijk, J. P. ^{[27
]}

Biscaglia, S. ^{[30
]}

Mogensen, L. J. H. ^{[1
]}

Henareh, L. ^{[12
]}

Burzotta, F. ^{[31
]}

Eek, C. H. ^{[18
]}

Mylotte, D. ^{[32
]}

Llinas, M. S. ^{[1
]}

Koltowski, L. ^{[33
]}

Knaapen, P. ^{[28
]}

Calic, S. ^{[19
]}

Witt, N. ^{[13
]}

Santos-Pardo, I ^{[13
]}

Watkins, S. ^{[22
]}

Lonborg, J. ^{[4
]}

Kristensen, A. T. ^{[2
]}

Jensen, L. O. ^{[5
]}

Calais, F. ^{[14
]}

Cockburn, J. ^{[23
]}

Mcneice, A. ^{[24
]}

Kajander, O. A. ^{[34
]}

Heestermans, T. ^{[29
]}

Kische, S. ^{[35
]}

Eftekhari, A. ^{[6
]}

Spratt, J. C. ^{[25
,26
]}

Christiansen, E. H. ^{[1
]}

机构：

[1] Aarhus Univ Hosp, Dept Cardiol, Palle Juul Jensens Blvd 99, DK-8200 Aarhus N, Denmark

[2] Gentofte Univ Hosp, Dept Cardiol, Gentofte, Denmark

[3] Zealand Univ Hosp, Dept Cardiol, Roskilde, Denmark

[4] Rigshosp, Dept Cardiol, Copenhagen, Denmark

[5] Odense Univ Hosp, Dept Cardiol, Odense, Denmark

[6] Aalborg Univ Hosp, Dept Cardiol, Aalborg, Denmark

[7] North Estonia Med Ctr, Dept Cardiol, Tallinn, Estonia

[8] Univ Latvia, Pauls Stradins Clin Univ Hosp, Riga, Latvia

[9] Univ Hosp Leuven, Dept Cardiovasc Med, Leuven, Belgium

[10] Ziekenhuis Oost Limburg, Dept Cardiol, Genk, Limburg, Belgium

[11] Sahlgrens Univ Hosp, Dept Cardiol, Gothenburg, Sweden

[12] Karolinska Univ Hosp, Dept Cardiol, Stockholm, Sweden

[13] Karolinska Inst, Dept Clin Sci & Educ, Unit Cardiol, Sodersjukhuset, Stockholm, Sweden

[14] Orebro Univ Hosp, Dept Cardiol, Orebro, Sweden

[15] Oslo Univ Hosp, Dept Cardiol, Ulleval, Sweden

[16] Trondheim Reg & Univ Hosp, Dept Cardiol, Trondheim, Norway

[17] Trondheim Reg & Univ Hosp, Dept Cardiol, Trondheim, Norway

[18] Oslo Univ Hosp, Dept Cardiol, Oslo, Norway

[19] Sorlandet Sykehus Arendal, Dept Cardiol, Arendal, Norway

[20] Wythenshawe Hosp, Manchester Acad Hlth Sci Ctr, Dept Cardiol, Manchester, England

[21] Royal Bournemouth Hosp, Dept Cardiol, Bournemouth, England

[22] Golden Jubilee Hosp, Dept Cardiol, Glasgow, Scotland

[23] Sussex Cardiac Ctr, Dept Cardiol, Brighton, England

[24] Belfast Hlth & Social Care Trust, Dept Cardiol, Belfast, North Ireland

[25] St Georges Univ London, St Georges Univ Hosp NHS Fdn Trust, Cardiol Care Grp, London, England

[26] St Georges Univ London, Cardiovasc Clin Acad Grp, London, England

[27] St Antonius Ziekenhaus, Dept Cardiol, Nieuwegein, Netherlands

[28] Amsterdam UMC, Dept Cardiol, Amsterdam, Netherlands

[29] Northwest Hosp Alkmaar, Dept Cardiol, Alkmaar, Netherlands

[30] Azienda Osped Univ Ferrara, Cardiol Unit, Ferrara, Italy

[31] Univ Cattolica Sacro Cuore, Fdn Policlin Univ Agostino Gemelli IRCCS, Dept Cardiovasc Sci, Rome, Italy

[32] Univ Hosp Galway, Dept Cardiol, Galway, Ireland

[33] Med Univ Warsaw, Dept Cardiol 1, Warsaw, Poland

[34] Tampere Univ Hosp, Tampere Heart Hosp, Tampere, Finland

[35] Vivantes Klinikum Friedrichshain, Berlin, Germany

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2023年 / 389卷 / 16期

关键词：

PERCUTANEOUS CORONARY INTERVENTION; OPTICAL COHERENCE TOMOGRAPHY; DRUG-ELUTING STENT; INTRAVASCULAR ULTRASOUND; OUTCOMES; IMPACT;

D O I：

10.1056/NEJMoa2307770

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BackgroundImaging-guided percutaneous coronary intervention (PCI) is associated with better clinical outcomes than angiography-guided PCI. Whether routine optical coherence tomography (OCT) guidance in PCI of lesions involving coronary-artery branch points (bifurcations) improves clinical outcomes as compared with angiographic guidance is uncertain.MethodsWe conducted a multicenter, randomized, open-label trial at 38 centers in Europe. Patients with a clinical indication for PCI and a complex bifurcation lesion identified by means of coronary angiography were randomly assigned in a 1:1 ratio to OCT-guided PCI or angiography-guided PCI. The primary end point was a composite of major adverse cardiac events (MACE), defined as death from a cardiac cause, target-lesion myocardial infarction, or ischemia-driven target-lesion revascularization at a median follow-up of 2 years.ResultsWe assigned 1201 patients to OCT-guided PCI (600 patients) or angiography-guided PCI (601 patients). A total of 111 patients (18.5%) in the OCT-guided PCI group and 116 (19.3%) in the angiography-guided PCI group had a bifurcation lesion involving the left main coronary artery. At 2 years, a primary end-point event had occurred in 59 patients (10.1%) in the OCT-guided PCI group and in 83 patients (14.1%) in the angiography-guided PCI group (hazard ratio, 0.70; 95% confidence interval, 0.50 to 0.98; P=0.035). Procedure-related complications occurred in 41 patients (6.8%) in the OCT-guided PCI group and 34 patients (5.7%) in the angiography-guided PCI group.ConclusionsAmong patients with complex coronary-artery bifurcation lesions, OCT-guided PCI was associated with a lower incidence of MACE at 2 years than angiography-guided PCI. (Funded by Abbott Vascular and others; OCTOBER ClinicalTrials.gov number, NCT03171311.) In patients with coronary bifurcation lesions, optical coherence tomography-guided PCI was associated with a lower incidence of major adverse cardiac events at a median 2 years of follow-up than angiography-guided PCI.

引用

页码：1477 / 1487

页数：11

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