Author + information
- Received December 13, 2017
- Revision received January 16, 2018
- Accepted January 30, 2018
- Published online July 16, 2018.
- Daniel A. Jones, MD, PhDa,∗ (, )
- Krishnaraj S. Rathod, MDa,
- Sudheer Koganti, MDa,
- Stephen Hamshere, MDb,
- Zoe Astroulakis, MD, PhDc,
- Pitt Lim, MDc,
- Alexander Sirker, MD, PhDa,
- Constantinos O’Mahony, MDa,
- Ajay K. Jain, MDa,
- Charles J. Knight, MDa,
- Miles C. Dalby, MDd,
- Iqbal S. Malik, MBBS, PhDb,
- Anthony Mathur, MD, PhDa,
- Roby Rakhit, MDe,
- Tim Lockie, MBChB, PhDe,
- Simon Redwood, MDf,
- Philip A. MacCarthy, MBChB, PhDg,
- Ranil Desilva, MD, PhDd,
- Roshan Weerackody, MD, PhDa,
- Andrew Wragg, MD, PhDa,
- Elliot J. Smith, MDa and
- Christos V. Bourantas, MD, PhDa
- aDepartment of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- bDepartment of Cardiology, Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, London, United Kingdom
- cDepartment of Cardiology, St. George’s Healthcare NHS Foundation Trust, St. George’s Hospital, London, United Kingdom
- dDepartment of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom
- eDepartment of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom
- fDepartment of Cardiology, St Thomas' NHS Foundation Trust, Guy’s & St Thomas’ Hospital, London, United Kingdom
- gDepartment of Cardiology, King’s College Hospital, King’s College Hospital NHS Foundation Trust, London, United Kingdom
- ↵∗Address for correspondence:
Dr. Daniel A. Jones, Department of Cardiology, Barts Heart Centre, St. Bartholomew’s Hospital, West Smithfield, London EC1A 7BE, United Kingdom.
Objectives This study aimed to determine the effect on long-term survival of using optical coherence tomography (OCT) during percutaneous coronary intervention (PCI).
Background Angiographic guidance for PCI has substantial limitations. The superior spatial resolution of OCT could translate into meaningful clinical benefits, although limited data exist to date about their effect on clinical endpoints.
Methods This was a cohort study based on the Pan-London (United Kingdom) PCI registry, which includes 123,764 patients who underwent PCI in National Health Service hospitals in London between 2005 and 2015. Patients undergoing primary PCI or pressure wire use were excluded leaving 87,166 patients in the study. The primary endpoint was all-cause mortality at a median of 4.8 years.
Results OCT was used in 1,149 (1.3%) patients, intravascular ultrasound (IVUS) was used in 10,971 (12.6%) patients, and angiography alone in the remaining 75,046 patients. Overall OCT rates increased over time (p < 0.0001), with variation in rates between centers (p = 0.002). The mean stent length was shortest in the angiography-guided group, longer in the IVUS-guided group, and longest in the OCT-guided group. OCT-guided procedures were associated with greater procedural success rates and reduced in-hospital MACE rates. A significant difference in mortality was observed between patients who underwent OCT-guided PCI (7.7%) compared with patients who underwent either IVUS-guided (12.2%) or angiography-guided (15.7%; p < 0.0001) PCI, with differences seen for both elective (p < 0.0001) and acute coronary syndrome subgroups (p = 0.0024). Overall this difference persisted after multivariate Cox analysis (hazard ratio [HR]: 0.48; 95% confidence interval [CI]: 0.26 to 0.81; p = 0.001) and propensity matching (hazard ratio: 0.39; 95% CI: 0.21 to 0.77; p = 0.0008; OCT vs. angiography-alone cohort), with no difference in matched OCT and IVUS cohorts (HR: 0.88; 95% CI: 0.61 to 1.38; p = 0.43).
Conclusions In this large observational study, OCT-guided PCI was associated with improved procedural outcomes, in-hospital events, and long-term survival compared with standard angiography-guided PCI.
Dr. Dalby has served as a consultant for AstraZeneca, Eli Lilly, Medtronic, Edwards Lifesciences, and Boston Scientific; and has received research grant support from Abbott Vascular, Daiichi-Sankyo Lilly, and Sanofi. Dr. Smith has served as a proctor for chronic total occlusion procedures for Boston Scientific, Vascular Perspectives, Biosensors International, and Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 13, 2017.
- Revision received January 16, 2018.
- Accepted January 30, 2018.
- 2018 American College of Cardiology Foundation