Petr Kala1, Pavel Cervinka2, Martin Jakl3, Jan Kanovsky1, Andrej Kupec4, Radim Spacek4, Martin Kvasnak4, Martin Poloczek5, Michaela Cervinkova6, Hiram Bezerra7, Zdenek Valenta8, Guilherme F Attizzani7, Audrey Schnell7, Lu Hong9, Marco A Costa7. 1. Department of Cardiology and Internal Medicine, University Hospital Brno, Brno, Czech Republic; Medical Faculty of Masaryk University, Brno, Czech Republic. 2. Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital, UJEP Usti nad Labem, Usti nad Labem, Czech Republic. Electronic address: pavel.cervinka@kzcr.eu. 3. First Department of Cardio-Angiology and Internal Medicine, Faculty Hospital Hradec Kralove, Hradec Kralove, Czech Republic. 4. Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital, UJEP Usti nad Labem, Usti nad Labem, Czech Republic. 5. Department of Cardiology and Internal Medicine, University Hospital Brno, Brno, Czech Republic. 6. Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital, UJEP Usti nad Labem, Usti nad Labem, Czech Republic; First Department of Cardio-Angiology and Internal Medicine, Faculty Hospital Hradec Kralove, Hradec Kralove, Czech Republic. 7. Harrington Heart &Vascular Institute, University Hospitals Case Medical Center, Cleveland, USA. 8. Institute of Computer Science, Department of Statistical Medelling, Czech Academy of Sciences, Prague, Czech Republic. 9. Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.
Abstract
AIMS: To assess the possible merits of optical coherence tomography (OCT) guidance in primary percutaneous coronary intervention (pPCI). METHODS AND RESULTS:201 patients with ST-elevation myocardial infarction (STEMI) were enrolled in this study. Patients were randomized either to pPCI alone (angio-guided group, n=96) or to pPCI with OCT guidance (OCT-guided group, n=105) and also either to biolimus A9 or to everolimus-eluting stent implantation. All patients were scheduled for nine months of follow-up angiography and OCT study. OCT guidance led to post-pPCI optimization in 29% of cases (59% malapposition and 41% dissections). No complications were found related to the OCT study. OCT analysis at nine months showed significantly less in-segment area of stenosis (6% [-11, 19] versus 18% [3, 33]; p=0.0002) in favor of the OCT-guided group. The rate major adverse cardiovascular events were comparable at nine months in both groups (3% in the OCT group versus 2% in the angio-guided group; p=0.87). CONCLUSIONS: This study demonstrates the safety of OCT guidance during pPCI. The use of OCT optimized stent deployment in 1/3 of patients in this clinical scenario and significantly reduced in-segment area of stenosis at nine months of follow-up. Whether such improvements in OCT endpoints will have a positive impact on late clinical outcomes, they demand both a larger and longer-term follow-up study.
RCT Entities:
AIMS: To assess the possible merits of optical coherence tomography (OCT) guidance in primary percutaneous coronary intervention (pPCI). METHODS AND RESULTS: 201 patients with ST-elevation myocardial infarction (STEMI) were enrolled in this study. Patients were randomized either to pPCI alone (angio-guided group, n=96) or to pPCI with OCT guidance (OCT-guided group, n=105) and also either to biolimus A9 or to everolimus-eluting stent implantation. All patients were scheduled for nine months of follow-up angiography and OCT study. OCT guidance led to post-pPCI optimization in 29% of cases (59% malapposition and 41% dissections). No complications were found related to the OCT study. OCT analysis at nine months showed significantly less in-segment area of stenosis (6% [-11, 19] versus 18% [3, 33]; p=0.0002) in favor of the OCT-guided group. The rate major adverse cardiovascular events were comparable at nine months in both groups (3% in the OCT group versus 2% in the angio-guided group; p=0.87). CONCLUSIONS: This study demonstrates the safety of OCT guidance during pPCI. The use of OCT optimized stent deployment in 1/3 of patients in this clinical scenario and significantly reduced in-segment area of stenosis at nine months of follow-up. Whether such improvements in OCT endpoints will have a positive impact on late clinical outcomes, they demand both a larger and longer-term follow-up study.
Authors: Marc Rubinstein; Allison C Hu; Phil-Sang Chung; Jason H Kim; Kathryn E Osann; Paul Schalch; William B Armstrong; Brian J F Wong Journal: Lasers Med Sci Date: 2020-04-27 Impact factor: 3.161
Authors: Hong Lu; Juhwan Lee; Martin Jakl; Zhao Wang; Pavel Cervinka; Hiram G Bezerra; David L Wilson Journal: Sci Rep Date: 2020-02-07 Impact factor: 4.379