Original Research

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.

Sign in to read
the full article

Forgot your password?
No account yet?
Sign up for free!

Create my pcr account

Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from PCRonline.com

Volume 20 Number 15
Aug 5, 2024
Volume 20 Number 15
View full issue


Key metrics

Suggested by Cory

State-of-the-Art

10.4244/EIJ-D-23-00912 Oct 7, 2024
Optical coherence tomography to guide percutaneous coronary intervention
Almajid F et al
free

Debate

10.4244/EIJ-E-24-00008 May 10, 2024
We now have enough evidence to support systematic OCT in daily PCI practice: pros and cons
Ali ZA et al
free
Trending articles
172.05

Focus article

10.4244/EIJY19M08_01 Jan 17, 2020
EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion – an update
Glikson M et al
free
64.8

State-of-the-Art

10.4244/EIJ-D-24-00066 Apr 21, 2025
Management of complications after valvular interventions
Bansal A et al
free
42

Original Research

10.4244/EIJ-D-25-00331 May 21, 2025
One-month dual antiplatelet therapy followed by prasugrel monotherapy at a reduced dose: the 4D-ACS randomised trial
Jang Y et al
open access
26.5

Expert Review

10.4244/EIJ-D-24-00535 May 5, 2025
Catheter-based techniques for pulmonary embolism treatment
Costa F et al
X

The Official Journal of EuroPCR and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

EuroPCR EAPCI
PCR ESC
Impact factor: 9.5
2024 Journal Citation Reports®
Science Edition (Clarivate Analytics, 2025)
Online ISSN 1969-6213 - Print ISSN 1774-024X
© 2005-2025 Europa Group - All rights reserved