Hot Line Session Results
The invasive imaging technique of optical coherence tomography (OCT) can lead to better patient outcomes than with standard angiography-guided PCI, according to the Does Optical Coherence Tomography Optimise Results of Stenting? (DOCTORS) study presented in a Hot Line session yesterday and published simultaneously in Circulation. The study also demonstrated that OCT allowed clinicians to see significantly more thrombi and calcifications before stent implantation.
OCT involves introducing an imaging catheter into the coronary artery to check vessel size and lesion characteristics as well as stent positioning and expansion. It has several potential advantages over angiography including the ability to assess post-procedural results that cannot be seen by angiography.
The aim of DOCTORS was to evaluate whether the use of OCT during PCI would provide useful clinical information beyond that obtained by angiography alone. The aim was also to establish whether this information would modify physician decision-making, with impact on the functional result of angioplasty. The angioplasty assessment was based on fractional flow reserve (FFR) measured after stent implantation in a lesion responsible for NSTE-ACS.
The multicentre trial was performed in nine hospitals in France in 240 NSTE-ACS patients. They were randomised either to OCT before PCI and after stent implantation, or to standard fluoroscopy-guided PCI alone (angio group) performed before and after stent implantation.
The primary endpoint of FFR was significantly better in the OCT group than in the angio group (82.5% vs 64.2%). Also, the number of patients with a post-procedural FFR>0.90 was significantly higher in the OCT group (82.5% vs 64.2%).
Study presenter Nicolas Meneveau said additional prospective studies are needed before OCT can be recommended for standard use. However, he said the results from DOCTORS could translate into promising benefits. ‘Our findings add to the cumulating body of evidence in favour of a potential benefit of OCT to guide angioplasty,’ said Meneveau, from the University Hospital of Besancon, France.
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