| Contributors: |
Holm, Nr; Andreasen, Ln; Neghabat, O; Laanmets, P; Kumsars, I; Bennett, J; Olsen, Nt; Odenstedt, J; Hoffmann, P; Dens, J; Chowdhary, S; O'Kane, P; Bülow Rasmussen, Sh; Heigert, M; Havndrup, O; Van Kuijk, Jp; Biscaglia, S; Mogensen, Ljh; Henareh, L; Burzotta, F; H Eek, C; Mylotte, D; Llinas, M; Koltowski, L; Knaapen, P; Calic, S; Witt, N; Santos-Pardo, I; Watkins, S; Lønborg, J; Kristensen, At; Jensen, Lo; Calais, F; Cockburn, J; Mcneice, A; Kajander, Oa; Heestermans, T; Kische, S; Eftekhari, A; Spratt, Jc; Christiansen, Eh; OCTOBER Trial, Group |
| Description: |
Background Imaging-guided percutaneous coronary intervention (PCI) is associated with better clinical outcomes than angiography-guided PCI. Whether routine optical coherence tomography (OCT) guidance in PCI of lesions involving coronary-artery branch points (bifurcations) improves clinical outcomes as compared with angiographic guidance is uncertain. Methods We conducted a multicenter, randomized, open-label trial at 38 centers in Europe. Patients with a clinical indication for PCI and a complex bifurcation lesion identified by means of coronary angiography were randomly assigned in a 1:1 ratio to OCT-guided PCI or angiography-guided PCI. The primary end point was a composite of major adverse cardiac events (MACE), defined as death from a cardiac cause, target-lesion myocardial infarction, or ischemia-driven target-lesion revascularization at a median follow-up of 2 years. Results We assigned 1201 patients to OCT-guided PCI (600 patients) or angiography-guided PCI (601 patients). A total of 111 patients (18.5%) in the OCT-guided PCI group and 116 (19.3%) in the angiography-guided PCI group had a bifurcation lesion involving the left main coronary artery. At 2 years, a primary end-point event had occurred in 59 patients (10.1%) in the OCT-guided PCI group and in 83 patients (14.1%) in the angiography-guided PCI group (hazard ratio, 0.70; 95% confidence interval, 0.50 to 0.98; P=0.035). Procedure-related complications occurred in 41 patients (6.8%) in the OCT-guided PCI group and 34 patients (5.7%) in the angiography-guided PCI group. Conclusions Among patients with complex coronary-artery bifurcation lesions, OCT-guided PCI was associated with a lower incidence of MACE at 2 years than angiography-guided PCI. |