A recent randomised open-label trial, presented today at EuroPCR, revealed important findings on the efficacy of optical coherence tomography (OCT) in guiding angioplasty for left main (LM) coronary artery lesions. Conducted on patients presenting with NSTEMI (Non-ST-Elevation Myocardial Infarction), unstable angina, stable angina, or documented silent ischemia, the study compared OCT-guided angioplasty with traditional fluoroscopy-guided methods.
The primary objective was to evaluate whether OCT guidance offers superior outcomes as assessed by fractional flow reserve (FFR) post-stent implantation. Participants, who had angiographically significant lesions (% Diameter Stenosis [DS] ≥50%) or functionally significant lesions (FFR ≤0.80) in the LM, were randomly assigned to either the OCT group or the angiography group. The study included patients with SYNTAX scores ≤22, or those with scores between >22 and ≤32 validated by a Heart Team.
In the OCT-guided group, stent size and diameter were determined using pre-stenting OCT runs, and post-stenting OCT was employed to ensure optimal stent deployment and detect issues like edge dissection. Conversely, the angiography group underwent the procedure guided solely by fluoroscopy, with blinding to OCT data.
Key findings revealed that although OCT guidance did not significantly impact the absolute FFR functional result compared to fluoroscopy, it did result in significantly greater procedural success. Specifically, the OCT group exhibited fewer instances of stent malapposition and crushed stents. Additionally, the incidence of target lesion revascularisation (TLR) at one year was significantly lower in the OCT-guided group, highlighting its potential long-term benefits.
Overall, the study underscores the potential advantages of OCT-guided angioplasty in enhancing procedural outcomes and reducing the need for subsequent interventions, marking a significant advancement in the management of LM coronary artery disease.
Reference:
Meneveau N et al. Does OCT Optimise Results of Stenting on the Left Main: The randomized, controlled, multicentre DOCTORS-LM trial. EuroPCR 16.05.2024.
