Clinical effect of OCT-Guided PCI in Patients with Diabetes Mellitus: A prespecified substudy from the OCCUPI Trial

초록

Background: Patients with diabetes mellitus (DM) often present with complex coronary lesions, yet evidence supporting the use of optical coherence tomography (OCT)-guided PCI in this high-risk population remains limited. Methods: This was a prescribed subgroup analysis of the OCCUPI trial, a multicenter, randomized controlled trial that enrolled 1,604 patients with complex coronary lesions. Among them, 523 patients (32.6%) had DM. Patients were randomized to undergo OCT-guided or angiography-guided PCI. The primary endpoint was the 1-year incidence of major adverse cardiac events (MACE), defined as a composite of cardiac death, myocardial infarction (MI), stent thrombosis, or ischemia-driven target vessel revascularization. Results: In DM patients, the primary endpoint occurred significantly less frequently in the OCT-guided PCI group compared the angiography-guided group (4.2% vs. 9.2%, adjusted HR 0.42, 95% CI 0.20-0.85, P=0.016). This reduction was mainly driven by lower rates of MI and target vessel revascularization. No significant difference in MACE was observed in non-DM patients between the two strategies. Notably, stent optimization according to pre-defined OCT criteria was significantly associated with improved outcomes irrespective of DM status. Conclusion: In patients with DM and complex coronary lesions, OCT-guided PCI was associated with a significantly reduced risk of 1-year MACE compared to angiography-guided PCI. These findings highlight the potential importance of intravascular imaging, particularly in diabetic patients with high-risk lesion characteristics.