Angiographic co-Registration-Guided Percutaneous Coronary Intervention Superior to Other Guidance Methods

Angiographic co-registration (ACR)-guided percutaneous coronary intervention (PCI) outperformed other methods for reducing major edge dissection and longitudinal geographic mismatch, according to findings from a study published in Clinical Research in Cardiology.

In this prospective, randomized trial, open-label trial, 84 patients (mean age, 70 years;  72.6% men; 83.3% with hypertension; 23.8% with diabetes; 50.0% with a family history of coronary artery disease) with significant coronary artery disease identified using angiography were enrolled between 2017 and 2018. Participants were randomly assigned at a 1:1:1 ratio to receive ACR-guided, optical-coherence-tomography (OCT)-guided, or angiography-guided (n=28 in each group) PCI. A major edge dissection was defined as ³60° flap angle of the circumference of the vessel. A longitudinal geographic mismatch was defined as untreated plaques with a minimal lumen area <4.5 mm².

The participants in groups treated with ACR, OCT, and angiography PCI were well balanced for minimal lumen diameter (0.95 mm vs 1.00 mm vs 1.10 mm, respectively; P =.98), lesion length (17.25 mm vs 17.90 mm vs 18.40 mm, respectively; P =.54), and reference vessel diameter (2.86 mm vs 2.95 mm vs 2.97 mm, respectively; P =.92).

Incidences of edge dissections or geographic mismatch were reduced in patients receiving ACR-guided PCI (4.2%) compared with those receiving OCT-guided (19.1%; odds ratio [OR], 0.18; 95% CI, 0.04-0.90; P =.03) or angiography-guided PCI (25.5%; OR, 0.13; 95% CI, 0.03-0.60; P <.01), but not between the OCT- and angiography-guided PCI groups (OR, 1.45; 95% CI, 0.54-3.85; P =.46).

There was insufficient power to assess differences between groups in major or any edge dissection measurements. The incidence of longitudinal geographic mismatch observed among ACR-guided PCI recipients (4.2%) remained lower when compared with that in those receiving OCT- (17.0%; OR, 0.21; 95% CI, 0.04-0.98; P =.04) or angiography-guided PCI (22.9%; OR, 0.14; 95% CI, 0.03-0.69; P =.02).

No significant differences in malapposition (ACR vs OCT: P =.77; ACR vs angiography: P =.91; OCT vs angiography: P =.86), proximal minimal stent area (ACR vs OCT: P =.87; ACR vs angiography: P =.58; OCT vs angiography: P =.32), distal minimal stent area (ACR vs OCT: P =.35; ACR vs angiography: P =.55; OCT vs angiography: P =.66), or optimal stent expansion (ACR vs OCT: P =.25; ACR vs angiography: P =.13; OCT vs angiography: P =.69) were observed between treatment groups.

Compared with OCT-guided PCI, ACR- (OR, 0.17; 95% CI, 0.03-0.93; P =.04) or angiographic-guided PCI (OR, 0.12; 95% CI, 0.02-0.66; P =.02) were inversely related with edge dissections and geographic mismatches.

A major limitation of this study was that due to small sample sizes, the investigators were unable to examined associations between PCI method and clinical outcomes.

“[The trial] demonstrated a significant reduction in the composite primary endpoint of [longitudinal geographic mismatch] and/or major edge dissection — both relate with adverse outcomes following PCI — as compared [with] OCT- as well as to angiography-guided PCI, which was meanly driven by a reduction of [longitudinal geographic mismatch],” concluded the study authors.

Reference

Schneider V S, Böhm F, Blum K, et al. Impact of real‑time angiographic co‑registered optical coherence tomography on percutaneous coronary intervention: the OPTICO‑integration II trial. [published online September 5, 2020] Clin Res Cardiol. doi:10.1007/s00392-020-01739-1