Optical Coherence Tomography Versus Intravascular Ultrasound and Angiography to Guide Percutaneous Coronary Interventions

Author:

Chamié Daniel1ORCID,Costa J. Ribamar1,Damiani Lucas P.2ORCID,Siqueira Dimytri1,Braga Sérgio1,Costa Ricardo1,Seligman Henry3ORCID,Brito Freddy1ORCID,Barreto Guilherme1,Staico Rodolfo1,Feres Fausto1,Petraco Ricardo3,Abizaid Alexandre1

Affiliation:

1. Invasive Cardiology Department, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil (D.C., J.R.C., D.S., S.B., R.C., F.B., G.B., R.S., F.F., A.A.).

2. Research Institute, Hospital do Coração, Sao Paulo, Brazil (L.P.D.).

3. International Centre for Circulatory Health, Imperial College London, United Kingdom (H.S., R.P.).

Abstract

Background: Specific algorithms for use of optical coherence tomography (OCT) to guide percutaneous coronary intervention (PCI) are scarce. Also, the relative benefits of intravascular imaging guidance have not been tested against an optimized angiography-guided PCI strategy. In iSIGHT (Optical Coherence Tomography Versus Intravascular Ultrasound and Angiography to Guide Percutaneous Coronary Interventions), we aimed to investigate whether OCT-guided PCI achieves noninferior stent expansion compared with intravascular ultrasound (IVUS) guidance and if both imaging modalities lead to superior stent expansion compared with an optimized angiography-based strategy. Methods: Patients ≥18 years old undergoing PCI for ≥1 lesion in native coronaries of 2.25 to 4.00 mm in diameter were randomized 1:1:1 to OCT-, IVUS-, or angiography-guided PCI. Predetermined guidance protocols were applied in all groups. An external elastic membrane–based protocol was used for stent sizing by OCT and IVUS. The primary end point was noninferiority of stent expansion (minimum stent area ≥90% of the average reference lumen area), measured by post-PCI OCT, in OCT-guided versus IVUS-guided PCI (noninferiority margin, 6.5%). Results: One hundred fifty-one patients (156 lesions) were randomly allocated to OCT (51 lesions [32.7%]), IVUS (52 lesions [33.3%]), or angiography (53 lesions [34.0%]). Stent expansion with OCT guidance (98.01±16.14%) was noninferior to IVUS (91.69±15.75%; 1-sided lower 95% CI, 0.55 mm 2 ; P non-inferiority <0.001) and superior to angiography (90.53±14.84%, P =0.041). IVUS and angiography obtained similar stent expansions ( P =0.921). Stent edge dissection and periprocedural complication rates were not significantly different among the groups. Conclusions: Stent expansion with OCT guidance using a dedicated external elastic membrane–based sizing strategy was noninferior to that achieved with IVUS and superior to an optimized angiographic strategy. Registration: URL: plataformabrasil.saude.gov.br ; Unique identifier: 69968417.8.0000.5462.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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