Impact of Optical Coherence Tomography-Guided Percutaneous Coronary Intervention for the Complex Lesions According to Lesion Length and Vessel Diameter: Results from the OCCUPI Randomized Trial

초록

Methods: A total of 1,604 patients with complex lesions from the OCCUPI (Optical Coherence Tomography-guided Coronary Intervention in Patients with Complex Lesions) trial were classified according to the median lesion length and reference vessel diameter by quantitative coronary angiographic assessment. And then the occurrence of the primary endpoint was the 1-year incidence of major adverse cardiac events (MACE), including cardiac death, myocardial infarction, stent thrombosis, or ischemia-driven target vessel revascularization were compared among the groups. Results: The median values of lesion length and reference vessel diameter among the total OCCUPI population were 32 mm and 2.8 mm, respectively. When comparing the occurrences of the primary endpoint based on these values, OCT-guidance compared to the angiography guidance had lower incidence of MACE in patients with lesion length ≥32 mm (HR: 0.55; 95% CI: 0.32–0.95; P=0.031) and reference vessel diameter <2.8 mm (HR: 0.51; 95% CI: 0.28–0.92; P=0.026), respectively (Figure A). Among the groups stratified by lesion length and reference vessel diameter, the effect of OCT guidance was consistent for the reduction of MACE across the groups (P for interaction = 0.526), particularly in the group of lesion length ≥32 mm with reference vessel diameter <2.8 mm (HR: 0.46; 95% CI: 0.23–0.94; P=0.033) (Figure B) Conclusion: This subgroup analysis showed no heterogeneity in the effect of OCT-guided PCI, compared with angiography-guided PCI, for the MACE across lesion length and vessel diameter, more pronouncing in long lesion or small vessel disease.