Suresh Patted, Sanjay Porwal*, Sameer Ambar, Prasad MR, Vijay Metgudmath, Anup Hanchinal, Vaibhav Patil, Vishwanath Hesarur, and Suhasini Atharga
Purpose: Optical coherence tomography (OCT) provides superior-resolution images than coronary angiography and accurately evaluates the vessel size and plaque morphology guiding the treatment strategy before and after stent implantations. Very limited data is available in the public domain in India on OCT-guided PCI. The aim of this study is to assess the safety and effectiveness of OCT-guided PCI in a real-world setting in India.
Methods: Records of patients ≥ 18 years who underwent OCT-guided PCI between April 2016 and December 2018 at KLE’s Hospital, Department of Cardiology and had one-year follow-up data were retrospectively analysed. All patients underwent pre- and post-PCI angiography and post-PCI OCT. The primary endpoint was post-PCI minimum stent area (MSA) and target lesion failure (TLF) at one year.
Results: A total of 204 patients with 299 coronary lesions were analysed. Pre-dilatation and post-dilatation were performed in 82% and 58% of cases, respectively. The mean MSA and stent expansion with OCT guidance was 4.57 ± 1.82 mm2 and 81.80 ± 14.01%, respectively. No edge dissection, thrombus, abrupt closure, or perforation were observed on post-PCI angiography. OCT was useful in detecting stent malapposition (3%), stent dissection (1%), and tissue/thrombus prolapse (10%). Post-stenting optimisation was done in 8% of cases. Post-PCI OCT was associated with better clinical outcomes with a very low incidence of target lesion failure (TLF) at one year (1.5%).
Conclusions: Optical coherence tomography-guided PCI was safe and resulted in optimal MSA. It was also beneficial in detecting suboptimal stent deployment and optimising PCI with better clinical outcomes at one year after the index PCI.
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