TY - JOUR
T1 - Trends and outcomes of optical coherence tomography use: 877 patients single-center experience
AU - Paraggio, Lazzaro
AU - Burzotta, Francesco
AU - Aurigemma, Cristina
AU - Scalise, Renato
AU - Leone, Antonio Maria
AU - Niccoli, Giampaolo
AU - Porto, Italo
AU - Genuardi, Lorenzo
AU - Dato, Ilaria
AU - Trani, Carlo
AU - Crea, Filippo
PY - 2019
Y1 - 2019
N2 - Background: Optical-coherence-tomography (OCT) is an emerging invasive coronary imaging with still undefined clinical value. Recent data have underlined daily impact of such technique in several clinical settings such as acute coronary syndromes (ACS) and percutaneous coronary intervention (PCI) guidance. We aimed at assessing the trends and outcomes of OCT use in a high-volume percutaneous coronary interventions (PCI)-center. Methods: Over 6 years, 1025 coronary artery segments in 877 patients underwent OCT evaluation. Clinical and procedural characteristics were prospectively collected. Clinical setting for OCT was: “Diagnostic OCT” (OCT for lesion evaluation after coronary angiography without further PCI); “PCI-guidance OCT” (OCT as a guidance for complex PCI, both by intention or after diagnostic OCT). Primary study end-point was the occurrence of target-vessel-failure (TVF) during the follow-up. Results: Overall, OCT was successful in 99.1% of attempted lesions. Only one complication (coronary dissection requiring urgent PCI) occurred during OCT. After a follow-up of 695 ± 562 days, TVF occurred in 8.2% of cases. Despite similar baseline characteristics, TVF-free survival curves were different in the two populations (5.4% after diagnostic OCT and 9.9% after PCI-guidance OCT). Minimal-lumen-area (MLA) of target lesion was independently associated with TVF (HR 0.7, 95% CI 0.6–0.8). This was mainly driven by a significant impact of MLA in patients not revascularized (HR 0.6, 95% CI 0.4–0.9). TVF did not change according to the study period despite the selection of patients with increasing complexity. Conclusions: OCT has a good safety profile across a broad spectrum of patients encountered in daily practice. The easy-to-assess MLA parameter may help stratify prognosis of patients undergoing OCT. These data call for further evaluations of OCT clinical impact. OCT is a light-based imaging tool which had subvert the quite ordinary world of coronary imaging and the present study evaluates OCT use in a high-volume center. Our results suggest that application of OCT in “real world” patients presenting higher risk has a good safety profile. Several factors could predict a worse long-term outcome in patients undergoing OCT evaluation, mostly related to more complex clinical conditions. These findings could encourage even low-to intermediate volume centers to improve their OCT use in daily practice.
AB - Background: Optical-coherence-tomography (OCT) is an emerging invasive coronary imaging with still undefined clinical value. Recent data have underlined daily impact of such technique in several clinical settings such as acute coronary syndromes (ACS) and percutaneous coronary intervention (PCI) guidance. We aimed at assessing the trends and outcomes of OCT use in a high-volume percutaneous coronary interventions (PCI)-center. Methods: Over 6 years, 1025 coronary artery segments in 877 patients underwent OCT evaluation. Clinical and procedural characteristics were prospectively collected. Clinical setting for OCT was: “Diagnostic OCT” (OCT for lesion evaluation after coronary angiography without further PCI); “PCI-guidance OCT” (OCT as a guidance for complex PCI, both by intention or after diagnostic OCT). Primary study end-point was the occurrence of target-vessel-failure (TVF) during the follow-up. Results: Overall, OCT was successful in 99.1% of attempted lesions. Only one complication (coronary dissection requiring urgent PCI) occurred during OCT. After a follow-up of 695 ± 562 days, TVF occurred in 8.2% of cases. Despite similar baseline characteristics, TVF-free survival curves were different in the two populations (5.4% after diagnostic OCT and 9.9% after PCI-guidance OCT). Minimal-lumen-area (MLA) of target lesion was independently associated with TVF (HR 0.7, 95% CI 0.6–0.8). This was mainly driven by a significant impact of MLA in patients not revascularized (HR 0.6, 95% CI 0.4–0.9). TVF did not change according to the study period despite the selection of patients with increasing complexity. Conclusions: OCT has a good safety profile across a broad spectrum of patients encountered in daily practice. The easy-to-assess MLA parameter may help stratify prognosis of patients undergoing OCT. These data call for further evaluations of OCT clinical impact. OCT is a light-based imaging tool which had subvert the quite ordinary world of coronary imaging and the present study evaluates OCT use in a high-volume center. Our results suggest that application of OCT in “real world” patients presenting higher risk has a good safety profile. Several factors could predict a worse long-term outcome in patients undergoing OCT evaluation, mostly related to more complex clinical conditions. These findings could encourage even low-to intermediate volume centers to improve their OCT use in daily practice.
KW - Aged
KW - Clinical Decision-Making
KW - Coronary Artery Disease
KW - Female
KW - Hospitals, High-Volume
KW - Humans
KW - Male
KW - Middle Aged
KW - Optical coherence tomography
KW - Outcome and Process Assessment, Health Care
KW - Percutaneous Coronary Intervention
KW - Percutaneous coronary interventions
KW - Predictive Value of Tests
KW - Retrospective Studies
KW - Risk Factors
KW - Rome
KW - Time Factors
KW - Tomography, Optical Coherence
KW - Treatment Outcome
KW - Trends and outcomes
KW - Aged
KW - Clinical Decision-Making
KW - Coronary Artery Disease
KW - Female
KW - Hospitals, High-Volume
KW - Humans
KW - Male
KW - Middle Aged
KW - Optical coherence tomography
KW - Outcome and Process Assessment, Health Care
KW - Percutaneous Coronary Intervention
KW - Percutaneous coronary interventions
KW - Predictive Value of Tests
KW - Retrospective Studies
KW - Risk Factors
KW - Rome
KW - Time Factors
KW - Tomography, Optical Coherence
KW - Treatment Outcome
KW - Trends and outcomes
UR - http://hdl.handle.net/10807/167745
U2 - 10.1016/j.carrev.2018.12.017
DO - 10.1016/j.carrev.2018.12.017
M3 - Article
SN - 1553-8389
VL - 20
SP - 303
EP - 310
JO - Cardiovascular Revascularization Medicine
JF - Cardiovascular Revascularization Medicine
ER -