Target vessel-related major adverse cardiac events were comparable between optical coherence tomography (OCT)-guided and intravascular ultrasound (IVUS)-guided primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI). These findings were reported in The American Journal of Cardiology from a multicenter registry-based analysis conducted in Japan.
The analysis included 2,291 patients selected from a multicenter registry of 2,777 consecutive patients with STEMI who underwent primary PCI within 24 hours of symptom onset at 12 hospitals. OCT guidance was used in 244 patients (10.7%). IVUS guidance was used in 2,047 patients (89.3%). The primary endpoint was target vessel-related major adverse cardiac events (TV-MACE), defined as cardiovascular death, target vessel revascularization, and target vessel-related myocardial infarction.
During a median follow-up of 722 days, TV-MACE occurred less frequently with OCT guidance in the unmatched analysis (9.8% vs. 14.5%; p = 0.051). This difference did not reach statistical significance. After propensity score matching of 187 patient pairs, TV-MACE rates were similar between groups (8.6% vs. 10.2%; p = 0.723).
Kaplan–Meier analysis showed no significant differences between imaging strategies for TV-MACE (hazard ratio 0.82, 95% confidence interval 0.42–1.59; p = 0.552). No significant differences were observed for cardiovascular death (hazard ratio 0.46, 95% confidence interval 0.16–1.32; p = 0.150). No significant differences were observed for target vessel revascularization (hazard ratio 1.07, 95% confidence interval 0.43–2.63; p = 0.891).
Procedural characteristics differed between groups. Procedures without stent implantation were more frequent with OCT guidance than with IVUS guidance (12.8% vs. 5.3%; p = 0.027). The number of stents per patient was lower with OCT guidance than with IVUS guidance (0.99 ± 0.52 vs. 1.15 ± 0.56; p = 0.006). Overall clinical outcomes remained comparable between OCT- and IVUS-guided primary PCI.
