OCT Improves Outcomes

OCT Improves Outcomes

OCT-guided PCI Improved Procedural Outcomes and Safety Results as Demonstrated in ILUMIEN IV1, OCTOBER2

OCT-guided PCI improved stent implantation results with larger stent area and stent expansion1

OCT reduced procedural complications1:

  • Major dissections
  • Major malapposition
  • Major tissue protrusion
  • Untreated focal reference segment disease
7% Larger MSA


Stent expansion impacts outcomes. Achieving optimal stent expansion (MSA area ≥ 90%) is proven to reduce rates of adverse cardiac events.3 Stent underexpansion is an indicator of adverse events, such as stent thrombosis and restenosis.3

OCT-guided PCI improved safety including reduced stent thrombosis (ST) rates as observed in ILUMIEN IV1,4

  • Significant reduction in ST 0.5% vs 1.4%, p=0.024
64% Lower ST


Stent thrombosis is a severe PCI complication that can lead to death or myocardial infarction.5
 

OCT-guided PCI improved clinical outcomes in complex bifurcation lesions with reduced MACE rates, as demonstrated in OCTOBER2

OCT-guided PCI reduced MACE by 28% compared to angiography2

28% MACE

OCT and IVUS showed comparable clinical results in OCTIVUS6

OCT-guided PCI demonstrated comparable results to IVUS-guided PCI in TVF at 1 year.6

  • TVF 2.5% OCT vs 3.1% IVUS, p<0.001 for non-inferiority at 1 year
  • Fewer major procedural complications in the OCT group (2.2% vs 3.7%)
  • Reduced procedural time in the OCT group
  • No differences in contrast-related risk between OCT and IVUS
     
No clinical difference between OCT and IVUS

Intravascular imaging to guide PCI is superior to angiography guidance, as demonstrated in the NETWORK META-ANALYSIS7

Routine use of intravascular imaging to guide PCI is superior to angiography and has shown to improve patient outcomes consistently in the network meta-analysis from 20 RCTs and 12,428 patients.7

Superior outcomes for imaging guidance compared to angiography alone7

Reduction:

46% Cardiac death
20% TV-MI
29% TLR

31% reduction TLF
Safety Benefits of Imaging:

52% Reduction ST
25% Reduction all cause mortality
18% Reduction MI

Safety shield graphic
OCT Relative Risk Chart

Intravascular Imaging: Can We Still Ignore the Evidence?

Watch Dr. Alasnag review all imaging clinical data presented at the European Society of Cardiology (ESC) 2023.

Imaging matters: new large body of data supports imaging benefit

Intravascular imaging data from over 12,000 patients was presented at the Europrean Society of Cardiology (ESC), solidifying that intravascular imaging should be the gold standard of care for better patient outcomes.

ILUMIEN IV1

OCT guided PCI vs. angio-guided PCI in complex cases

2,487

OCTOBER2

OCT guided PCI vs. angio-guided PCI in bifurcations

2,487

OCTIVUS6

OCT guided PCI vs. IVUS-guided PCI

2,487

NETWORK META7

OCT guided PCI vs. IVUS-guided PCI vs. angio alone

2,487

Societies and guidelines recommend imaging guidance for PCI

  • 2023 ESC Guidelines for The Management of Acute Coronary Syndromes recommend intravascular imaging to guide PCI and recommend OCT to guide PCI in patients with ambiguous culprit lesions.8
  • 2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology now require the knowledge of imaging and physiology devices, how to perform imaging-guided PCI as well as the outcomes data to support the use.9
  • ACC recommends that operators use IVI as an essential adjunct to angiography, that all US cardiac catheterization labs have IVI capability and national training programs provide training on IVI.10
  • The AHA/ACC 2021 Guidelines for use of intravascular imaging were updated and now recommend OCT imaging to guide stent implantation and to determine mechanism of stent underexpansion.11

Clinical Evidence in Detail

Clinical Evidence in Details
Clinical Evidence in Details

References

  1. Z Ali et al., Optical Coherence Tomography–Guided versus Angiography-Guided PCI, NEJM, DOI: 10.1056/NEJMoa230586
  2. N.R. Holm et al., OCT or Angiography Guidance for PCI in Complex Bifurcation Lesions, NEJM, DOI: 10.1056/NEJMoa2307770 (OCTOBER)
  3. Räber L, et al. Clinical use of intracoronary imaging. Part 1: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. Eur Heart J. 2018;39(35):3281-3300.
  4. Z Ali et al., Optical Coherence Tomography–Guided versus Angiography-Guided PCI. ESC2023 Presentation.
  5. Souteyrand, G. et al. Mechanisms of stent thrombosis analysed by optical coherence tomography: insights from the national PESTO French registry. European Heart Journal, 2016:37:1208-1216.
  6. D Kang et al., Optical Coherence Tomography-Guided or Intravascular Ultrasound Guided Percutaneous Coronary Intervention: The OCTIVUS Randomized Clinical Trial, 10.1161/CIRCULATIONAHA.123.066429
  7. Stone et al., Meta-Analysis Presentation, ESC 2023
  8. 2023 ESC Guidelines for the management of acute coronary syndromes. Developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC). European Heart Journal (2023) 00, 1–107. doi.org/10.1093/eurheartj/ehad191
  9. 2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions): A Report of the ACC Competency Management Committee | Circulation: Cardiovascular Interventions. 2023;0:e000088 https://doi.org/10.1161/HCV.0000000000000088.
  10. Truesdell AG, Alasnag MA, Kaul P, et al. Intravascular Imaging During Percutaneous Coronary Intervention: JACC State-of-the-Art Review. J Am Coll Cardiol. 2023;81(6):590-605. doi:10.1016/j.jacc.2022.11.045.
  11. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145:e18–e114. DOI: 10.1161/CIR.0000000000001038.

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