20 Oct 2023 • In 15 to 20% of patients in whom coronary-artery revascularization is indicated, the lesion involves a branch point or bifurcation of the coronary artery. 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, as per study results published in the NEJM.

• In a multicenter, randomized trial conducted across 38 European centers, researchers compared two approaches for percutaneous coronary intervention in patients with complex bifurcation lesions identified through coronary angiography.
• They randomly assigned 1201 patients to undergo either optical coherence tomography (OCT)-guided PCI or angiography-guided PCI. The primary outcome, a composite of major adverse cardiac events such as cardiac-related death, target-lesion myocardial infarction, or ischemia-driven target-lesion revascularization, was assessed at a median follow-up of 2 years.
• The results revealed that at the 2-year mark, the OCT-guided PCI group had a lower MACE incidence (10.1%) compared to the angiography-guided PCI group (14.1%). Notably, procedure-related complications were slightly higher in the OCT-guided PCI group (6.8%) compared to the angiography-guided PCI group (5.7%).

This study's findings suggest that among patients with complex coronary-artery bifurcation lesions, OCT-guided PCI may be a preferable approach, yielding a reduced risk of MACE at the 2-year follow-up.

Source: NEJM | Read full story