Optical coherence tomography–guided PCI in left anterior descending versus non–left anterior descending lesions: a prespecified substudy of the OCCUPI trial
J H Heo, K S J Kim, L S J Lee, L S H Lee, H S J Hong, C D J Cho, K J W Kim, L J Y Lee, K B K KimAbstract
Purpose
The OCCUPI trial demonstrated the clinical benefit of optical coherence tomography (OCT)–guided percutaneous coronary intervention (PCI) in patients with complex coronary lesions. However, whether the effect of OCT guidance differs according to coronary lesion vessel remains unclear. This prespecified substudy evaluated the consistency of clinical outcomes with OCT-guided PCI in left anterior descending (LAD) versus non-LAD coronary vessels.
Methods
Among 1,375 patients without left main disease enrolled in the OCCUPI trial, 888 had LAD lesions and 487 had non-LAD lesions. Patients were randomized to undergo PCI guided by either OCT or conventional angiography. The primary endpoint was 1-year major adverse cardiovascular events (MACE), defined as a composite of cardiac death, myocardial infarction, stent thrombosis, or ischemia-driven target-vessel revascularization (TVR). Event rates were assessed using Kaplan–Meier analysis, and group differences were compared using the log-rank test.
Results
In the LAD group, 1-year MACE occurred in 4.5% of patients treated with OCT-guided PCI and 5.5% of those treated with angiography-guided PCI, with no statistically significant difference on Kaplan–Meier analysis (overall log-rank p = 0.486). In the non-LAD group, corresponding MACE rates were 4.6% and 7.7%, respectively, also without a significant difference (overall log-rank p = 0.154). There was no significant interaction between lesion location and PCI guidance strategy (p for interaction = 0.351). Ischemia-driven TVR occurred less frequently with OCT-guided PCI in both LAD and non-LAD lesions, without evidence of heterogeneity according to lesion location (p for interaction = 0.872).
Conclusions
In patients with complex coronary lesions, OCT-guided PCI was associated with fewer repeat revascularizations and a consistent trend toward improved clinical outcomes compared with angiography-guided PCI, irrespective of coronary lesion location.MACE for angiography/OCT guided PCIFor image description, please refer to the figure legend and surrounding text.