RCT: Optical Coherence Tomography (OCT)-Guided PCI Lowers Adverse Cardiac Events Compared to Angiography in Complex Lesions

Study Design and Population: This multicenter, randomized, open-label superiority trial (OCCUPI) compared optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) with angiography-guided PCI in patients with complex coronary lesions. The trial was conducted across 20 hospitals in South Korea, enrolling 1,604 patients aged 19–85 years requiring drug-eluting stents. Participants were randomized into OCT-guided PCI (n=803) or angiography-guided PCI (n=801), with outcomes assessed over 1 year.

Main Findings: At 1 year, major adverse cardiac events (MACE), including cardiac death, myocardial infarction, stent thrombosis, and ischemia-driven target-vessel revascularization, occurred in 5% of patients in the OCT-guided group compared to 7% in the angiography-guided group. The reduction in events was mainly driven by lower rates of spontaneous myocardial infarction and target-vessel revascularization in the OCT group. Secondary outcomes, such as stroke or contrast-induced nephropathy, showed no significant differences between groups.

Implications for Practice: OCT-guided PCI was associated with a lower incidence of MACE in patients with complex coronary lesions. These findings suggest that OCT guidance may provide additional benefit in stent optimization compared to angiography alone.

Reference: Hong SJ et al. (2024). Optical coherence tomography-guided versus angiography-guided percutaneous coronary intervention for patients with complex lesions (OCCUPI): an investigator-initiated, multicentre, randomised, open-label, superiority trial in South Korea. The Lancet. DOI: https://doi.org/10.1016/S0140-6736(24)01454-5

link: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01454-5/fulltext