Coronary interventions

Safety and efficiency of percutaneous coronary intervention using a standardised optical coherence tomography workflow

EuroIntervention 2023;18:1178-1187. DOI: 10.4244/EIJ-D-22-00512

Eric Osborn
Eric A. Osborn1, MD, PhD; Michael Johnson2, MD; Aziz Maksoud3,4, MD; Daniel Spoon5, MD; Frank J. Zidar6, MD; Ethan C. Korngold7, MD; Jana Buccola8, MS; Hector Garcia Cabrera8, MS; Richard J. Rapoza8, PhD; Nick E.J. West8, MD; Judah Rauch2, MD
1. Cardiology Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; 2. Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY, USA; 3. Cardiovascular Research Institute of Kansas, University of Kansas School of Medicine, Wichita, KS, USA; 4. Kansas Heart Hospital, Wichita, KS, USA; 5. International Heart Institute of Montana, Missoula, MT, USA; 6. Austin Heart, Austin, TX, USA; 7. Providence Heart Institute, Portland, OR, USA; 8. Abbott Vascular, Santa Clara, CA, USA

Background: While intravascular imaging guidance during percutaneous coronary intervention (PCI) improves outcomes, routine intravascular imaging usage remains low, in part due to perceived inefficiency and safety concerns. 

Aims: The LightLab (LL) Initiative was designed to evaluate whether implementing a standardised optical coherence tomography (OCT) workflow impacts PCI safety metrics and procedural efficiency.

Methods: In this multicentre, prospective, observational study, PCI procedural data were collected over 2 years from 45 physicians at 17 US centres. OCT-guided PCI incorporating the LL workflow (N=264), a structured algorithm using routine pre- and post-PCI OCT imaging, was compared with baseline angiography-only PCI (angio) (N=428). Propensity score analysis identified 207 matched procedures. Outcomes included procedure time, radiation exposure, contrast volume, device utilisation, and treatment strategy.

Results: Compared with angiography alone, LL workflow OCT-guided PCI increased the median procedural time by 9 minutes but reduced vessel preparation time (2 min LL workflow vs 3 min angio; p<0.001) and resulted in less unplanned additional treatment (4% LL workflow vs 10% angio; p=0.01). With LL workflow OCT guidance, fewer cineangiography views were needed compared to angiography guidance, leading to decreased radiation exposure (1,133 mGy LL workflow vs 1,269 mGy angio; p=0.02), with no difference in contrast utilisation between groups (p=0.28). Furthermore, LL workflow OCT guidance resulted in fewer predilatation balloons and stents being used, more direct stent placement, and greater stent post-dilatation than angiography-guided PCI.

Conclusions: The incorporation of a standardised pre- and post-PCI OCT imaging workflow improves procedural efficiency and safety metrics, at a cost of a modestly longer procedure time.

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efficiencyintravascular imagingoptical coherence tomographypercutaneous coronary interventionsafety
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