Luping He; Sining Hu; Chen Zhao; Yini Wang; Ziqian Weng; Yuhan Qin; Xue Feng; Huai Yu; Lulu Li; Yishuo Xu; Dirui Zhang; Yue Zhu; Yan Zuo; Wei Hao; Jianlin Ma; Ming Zeng; Boling Yi; Ning Wang; Yanli Sun; Zhanqun Gao; Ekaterina Koniaeva; Diler Mohammad; Jingbo Hou; Gary Mintz; Haibo Jia; Bo Yu

doi:10.4244/EIJ-D-24-00249

Five-year follow-up of OCT-guided percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction

Luping He¹^,², MD; Sining Hu¹^,², MD, PhD; Chen Zhao¹^,², MD; Yini Wang¹^,², MD, PhD; Ziqian Weng¹^,², MD, PhD; Yuhan Qin¹^,², MD, PhD; Xue Feng¹^,², MD, PhD; Huai Yu¹^,², MD, PhD; Lulu Li¹^,², MSc; Yishuo Xu¹^,², MD; Dirui Zhang¹^,², MD; Yue Zhu¹^,², MD; Yan Zuo¹^,², MD; Wei Hao¹^,², MD; Jianlin Ma¹^,², MD; Ming Zeng¹^,², MD; Boling Yi¹^,², MD; Ning Wang¹^,², MD; Yanli Sun¹^,², MD, PhD; Zhanqun Gao¹^,², MD, PhD; Ekaterina Koniaeva¹^,², MD; Diler Mohammad¹^,², MD; Jingbo Hou¹^,², MD, PhD; Gary S. Mintz³, MD; Haibo Jia¹^,², MD, PhD; Bo Yu¹^,², MD, PhD

Abstract

Background: Compared with intravascular ultrasound guidance, there is limited evidence for optical coherence tomography (OCT) guidance during primary percutaneous coronary intervention (pPCI) in ST-segment elevation myocardial infarction (STEMI) patients.

Aims: We investigated the role of OCT in guiding a reperfusion strategy and improving the long-term prognosis of STEMI patients.

Methods: All patients who were diagnosed with STEMI and who underwent pPCI between January 2017 and December 2020 were enrolled and divided into OCT-guided versus angiography-guided cohorts. They had routine follow-up for up to 5 years or until the time of the last known contact. All-cause death and cardiovascular death were designated as the primary and secondary endpoints, respectively.

Results: A total of 3,897 patients were enrolled: 2,696 (69.2%) with OCT guidance and 1,201 (30.8%) with angiographic guidance. Patients in the OCT-guided cohort were less often treated with stenting during pPCI (62.6% vs 80.2%; p<0.001). The 5-year cumulative rates of all-cause mortality and cardiovascular mortality in the OCT-guided cohort were 10.4% and 8.0%, respectively, significantly lower than in the angiography-guided cohort (19.0% and 14.1%; both log-rank p<0.001). All 4 multivariate models showed that OCT guidance could significantly reduce 5-year all-cause mortality (hazard ratio [HR] in model 4: 0.689, 95% confidence interval [CI]: 0.551-0.862) and cardiovascular mortality (HR in model 4: 0.692, 95% CI: 0.536-0.895). After propensity score matching, the benefits of OCT guidance were consistent in terms of all-cause mortality (HR: 0.707, 95% CI: 0.548-0.913) and cardiovascular mortality (HR: 0.709, 95% CI: 0.526-0.955).

Conclusions: Compared with angiography alone, OCT guidance may change reperfusion strategies and lead to better long-term survival in STEMI patients undergoing pPCI. Findings in the current observational study should be further corroborated in randomised trials.

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