Key Points:
- In all-comer populations, coronary imaging guidance shows superior outcomes compared to conventional angiography in percutaneous coronary interventions (PCI).
- The OCCUPI trial demonstrated that OCT-guided PCI significantly improved clinical outcomes over conventional angiography-guided PCI in patients with complex coronary lesions.
Previous studies have showed that imaging-guided PCI is associated with improved clinical outcomes compared to conventional angiography for treating coronary lesions. Optical coherence tomography (OCT) is a high-resolution, light-based intravascular imaging technique that allows for detailed characterization of plaque components and precise measurement of vessel and stent dimensions. Recent findings have shown that OCT guidance improves outcomes in the revascularization of complex coronary lesions, especially those at bifurcation points. Building on these findings, the OCCUPI trial was designed to test whether OCT guidance could provide superior outcomes compared to traditional angiography in patients with complex coronary lesions.
The results of the OCCUPI trial were presented by Professor Byeong-Keuk Kim from Yonsei University Severance Hospital in Seoul, Korea, at a Hotline session during ESC 2024 in London, with simultaneous publication in The Lancet. In this study, 1,604 patients were randomized in a 1:1 fashion to undergo either OCT-guided or angiography-guided PCI. The primary outcome was a composite of cardiac death, myocardial infarction (MI), stent thrombosis, and target-vessel revascularization at 1 year. Nearly all participants completed the 1-year follow-up.
The trial results showed that the OCT-guided PCI group experienced a significantly lower rate of the primary composite endpoint compared to the angiography-guided group (4.6% vs. 7.4%) over a 1-year follow-up. Additionally, fewer spontaneous MI and target-vessel revascularization events occurred in the OCT-guided group than in the angiography-guided group. Of note, the incidence of contrast-induced nephropathy was similar between the two groups.
Discussing the trial’s implications, Professor Kim stated, “Our findings provide strong evidence that OCT-guided PCI offers substantial benefits for patients with complex coronary lesions compared to conventional angiography guidance.” He added, “The next step is to establish detailed standards for the optimal use of OCT to further enhance the clinical outcomes of PCI in complex cases, based on the findings of the OCCUPI trial.”