LATE BREAKING data from the OCCUPI trial were presented at the European Society of Cardiology (ESC) Congress 2024, revealing that use of optical coherence tomography (OCT) to guide drug-eluting stent implantation in patients with complex coronary lesions during percutaneous coronary intervention (PCI) reduced the combined risk for a composite of cardiac outcomes compared to traditional angiography-guided PCI.
Whilst angiography is the most frequently used method for PCI stent guidance, OCT-guided PCI has greater resolution and accuracy. Previous studies have also suggested that OCT-guided PCI yields more detailed information on the coronary vessels, plaques, and implanted stents than angiography-guided PCI.
The OCCUPI trial sought to evaluate the impact of OCT-guided PCI on a composite of outcomes including stent thrombosis, target vessel revascularisation, myocardial infarction (MI), and cardiac death.
In total, 1,604 patients aged ≥19 years with anatomically complex lesions requiring PCI using drug-eluting stents were enrolled from 20 centres in the Republic of Korea. Individuals were randomised to either OCT-guided (n=803) or angiography-guided (n=801) intervention. Completed 1-year follow-up was achieved for 99% of patients (n=1,588).
At 1-year, those who received OCT-guided intervention had a 38% combined reduction in risk for the composite of cardiac outcomes (n=37) compared to angiography-guided intervention (n=59). Furthermore, the investigators found that those who received OCT-guided intervention were 64% less likely to have a spontaneous MI (excluding periprocedural MI) than those in the angiography-guided group (0.9% versus 2.4%, respectively) and were 64% less likely to need target vessel revascularisation than those in the angiography-guided group (1.5% versus 4.1%, respectively). No significant difference in the incidence of post-PCI contrast-induced nephropathy occurred between the two groups.
Lead study investigator, Byeong-Keuk Kim, Yonsei University Severance Hospital, Seoul, Korea, commented: “Our findings provide more evidence that OCT guidance of PCI procedures in patients with complex lesions has a greater impact on improving their lives than conventional angiography guidance.” Kim suggested that based on the results of OCCUPI, a detailed standard for optimising the use of OCT in PCI for complex cases needs to be established moving forwards.
Darcy Richards, EMJ
Reference
Kim B-K. OCCUPI – Optical coherence tomography-guided coronary intervention in patients with complex lesions. ESC Congress 2024, 2 September 2024.
