Comparison between optical coherence tomography-guided and intravascular ultrasound-guided primary percutaneous coronary intervention for ST-segment elevation myocardial infarction

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  • Matsuwaki Yuji
    Department of Cardiology, Cardiovascular Center, Fujita Health University Hospital
  • Muramatsu Takashi
    Department of Cardiology, Cardiovascular Center, Fujita Health University Hospital
  • Ozaki Yukio
    Department of Cardiology, Fujita Health University Okazaki Medical Center
  • Uwatoko Takashi
    Department of Cardiology, Cardiovascular Center, Fujita Health University Hospital
  • Toriya Takuo
    Department of Cardiology, Cardiovascular Center, Fujita Health University Hospital
  • Takatsu Hidemaro
    Department of Cardiology, Fujita Health University Okazaki Medical Center
  • Yoshiki Yu
    Department of Cardiology, Fujita Health University Okazaki Medical Center
  • Yoshinaga Masataka
    Department of Cardiology, Cardiovascular Center, Fujita Health University Hospital
  • Ishikawa Masato
    Department of Cardiology, Cardiovascular Center, Fujita Health University Hospital
  • Ohota Masaya
    Department of Cardiology, Fujita Health University Okazaki Medical Center
  • Ota Hideaki
    Department of Cardiology, Cardiovascular Center, Fujita Health University Hospital
  • Izawa Hideo
    Department of Cardiology, Cardiovascular Center, Fujita Health University Hospital

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<p>Objective: To examine the clinical outcomes of optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) in patients presenting with ST-segment elevation myocardial infarction (STEMI).</p><p>Methods: We retrospectively investigated 533 consecutive patients who underwent primary PCI for STEMI between June 2016 and December 2020. The primary endpoint was a target lesion failure (TLF; defined as a composite of cardiac death, target vessel myocardial infarction, or target lesion revascularization). Propensity score (PS) matching was performed to allow direct comparison of OCT-guided and intravascular ultrasound (IVUS)-guided PCI.</p><p>Results: Patients in the OCT group (n=166) were younger than those in the IVUS group (n=367) and had a significantly higher left ventricular ejection fraction and estimated glomerular filtration rate. Killip class IV and left main stem disease were more common in the IVUS group. The median peak creatine kinase level was comparable between the two groups (1953 U/L vs 1603 U/L). A significantly larger amount of contrast was used in the OCT group (200 mL vs 165 mL; p<0.001). The cumulative incidence of TLF during a median follow-up of 2.2 years did not differ significantly between OCT and IVUS groups (9.6% vs 13.6%; p=0.221) but cardiac mortality was significantly higher in the IVUS group (8.7% vs 3.6%; p=0.047). After PS matching (n=161 in each group), there was no significant between-group difference in TLF or any other clinical outcome measures.</p><p>Conclusions: OCT-guided PCI demonstrated clinical outcomes in patients with STEMI that were comparable to those of IVUS-guided PCI despite considerable differences in background characteristics.</p>

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