OCT or Angiography Guidance for PCI in Complex Bifurcation Lesions.
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OCT or Angiography Guidance for PCI in Complex Bifurcation Lesions. / Holm, Niels R.; Andreasen, Lene N.; Neghabat, Omeed; Laanmets, Peep; Kumsars, Indulis; Bennett, Johan; Olsen, Niels T.; Odenstedt, Jacob; Hoffmann, Pavel; Dens, Jo; Chowdhary, Saqib; O'Kane, Peter; Bülow Rasmussen, Søren Haldur; Heigert, Matthias; Havndrup, Ole; Van Kuijk, Jan P.; Biscaglia, Simone; Mogensen, Lone J.H.; Henareh, Loghman; Burzotta, Francesco; Eek, Christian H.; Mylotte, Darren; Llinas, Miquel S.; Koltowski, Lukasz; Knaapen, Paul; Calic, Slobodan; Witt, Nils; Santos-Pardo, Irene; Watkins, Stuart; Lønborg, Jacob; Kristensen, Andreas T.; Jensen, Lisette O.; Calais, Fredrik; Cockburn, James; McNeice, Andrew; Kajander, Olli A.; Heestermans, Ton; Kische, Stephan; Eftekhari, Ashkan; Spratt, James C.; Christiansen, Evald H.; OCTOBER Trial Group.
I: New England Journal of Medicine, Bind 389, Nr. 16, 2023, s. 1477-1487.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - OCT or Angiography Guidance for PCI in Complex Bifurcation Lesions.
AU - Holm, Niels R.
AU - Andreasen, Lene N.
AU - Neghabat, Omeed
AU - Laanmets, Peep
AU - Kumsars, Indulis
AU - Bennett, Johan
AU - Olsen, Niels T.
AU - Odenstedt, Jacob
AU - Hoffmann, Pavel
AU - Dens, Jo
AU - Chowdhary, Saqib
AU - O'Kane, Peter
AU - Bülow Rasmussen, Søren Haldur
AU - Heigert, Matthias
AU - Havndrup, Ole
AU - Van Kuijk, Jan P.
AU - Biscaglia, Simone
AU - Mogensen, Lone J.H.
AU - Henareh, Loghman
AU - Burzotta, Francesco
AU - Eek, Christian H.
AU - Mylotte, Darren
AU - Llinas, Miquel S.
AU - Koltowski, Lukasz
AU - Knaapen, Paul
AU - Calic, Slobodan
AU - Witt, Nils
AU - Santos-Pardo, Irene
AU - Watkins, Stuart
AU - Lønborg, Jacob
AU - Kristensen, Andreas T.
AU - Jensen, Lisette O.
AU - Calais, Fredrik
AU - Cockburn, James
AU - McNeice, Andrew
AU - Kajander, Olli A.
AU - Heestermans, Ton
AU - Kische, Stephan
AU - Eftekhari, Ashkan
AU - Spratt, James C.
AU - Christiansen, Evald H.
AU - OCTOBER Trial Group
N1 - Publisher Copyright: © 2023 Massachusetts Medical Society.
PY - 2023
Y1 - 2023
N2 - Abstract 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. (Funded by Abbott Vascular and others; OCTOBER ClinicalTrials.gov number, NCT03171311.)
AB - Abstract 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. (Funded by Abbott Vascular and others; OCTOBER ClinicalTrials.gov number, NCT03171311.)
KW - Cardiology
KW - Cardiology General
KW - Coronary Disease/Myocardial Infarction
U2 - 10.1056/NEJMoa2307770
DO - 10.1056/NEJMoa2307770
M3 - Journal article
AN - SCOPUS:85175119309
VL - 389
SP - 1477
EP - 1487
JO - New England Journal of Medicine
JF - New England Journal of Medicine
SN - 0028-4793
IS - 16
ER -
ID: 397036216