Abstract 13805: Does Optical Coherence Tomography-Guided Angioplasty Yield Useful Clinical Information and Modify Physician Strategy?
Background: To date, no study has evaluated whether optical coherence tomography (OCT) contributes to optimising percutaneous coronary intervention (PCI) and stenting. We aimed to evaluate whether OCT-guided angioplasty would provide useful clinical information beyond that obtained by angiography, and whether this information would subsequently modify physician behaviour and treatment choices.
Methods: Prospective study of adult (>18 years) patients undergoing coronary angiography for ST and non-ST elevation myocardial infarction (STEMI, NSTEMI), stable angina (SA) or silent ischemia (SI). In all patients, 1 OCT run was performed (OCT-pre) after initial coronary angiography (angio-pre); and a 2nd run after angioplasty (OCT-post). We compared thrombus burden, calcification, and plaque rupture between OCT-pre and angio-pre recordings. After angioplasty, we compared stent malapposition, sub-optimal stent deployment, sub-optimal lesion coverage by the stent, and post-stent dissection as identified by OCT-post versus post-angioplasty fluoroscopy alone.
Results: Sixty-nine patients were included (13 STEMI, 23 NSTEMI, 27 SA, 6 SI); 44% presented single-vessel and 46% multivessel disease; 10% had atheroma without significant lesions. Results of OCT vs angiography findings are shown in the Table. OCT-pre and post-angioplasty revealed significantly more procedural information than angiography alone. This led to a change in treatment strategy in 35/69 (51%), namely thromboaspiration in 2(2.9%), additional stenting in 13 (18.8%), additional balloon inflation in 20 (29%) and use of GP IIb/IIIa inhibitors in 8/69 (11.6%).
Conclusion: Our results indicate that OCT performed before and after angioplasty provides additional clinical information beyond that obtained by angiography alone, and modifies treatment strategy in more than half of patients. It remains to be determined whether this translates into improved outcomes in the longer term.
- © 2012 by American Heart Association, Inc.