Work in progress: OCT-guided coronary interventions in the acute setting

Myocardial infarction has acted over time as an insurmountable obstacle to any innovative solution potentially capable of improving patient outcome. Since the adoption of primary angioplasty, which proved to be superior to thrombolysis in this regard, the testing of other pharmaceutical or interventional techniques has drawn a blank each time. Who cannot recall the failure of the randomised studies that evaluated the impact of upstream glycoprotein IIb-IIa inhibitors or low-dose thrombolytic drugs along the pathway of facilitated primary angioplasty12?

In this issue of EuroIntervention, He et al3 have explored, in an original paper, the clinical role of intracoronary imaging in the quest to improve the clinical outcome of ST-elevation myocardial infarction (STEMI). The authors performed a large prospective registry study of 3,897 patients with STEMI, mainly treated with optical coherence tomography (OCT)-guided interventions (69.2%).

Patients in the OCT-guided cohort more commonly had thrombus aspiration and were less often treated with stenting. The 5-year cumulative rates of all-cause and overall mortality were significantly higher in the angiography-guided cohort. Propensity score matching confirmed the effectiveness of OCT guidance in terms of...