OCTOBER trial: OCT-guided PCI improves clinical outcomes in bifurcation lesions

Optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) was superior to angiography-guided PCI in reducing the risk of cardiovascular adverse events in patients with complex bifurcation lesions in the OCTOBER trial.

The OCTOBER trial (NCT03171311) assessed whether stepwise, OCT-guided PCI improved clinical outcomes compared with angiography-guided PCI in 1,201 patients with stable or unstable angina or non-ST-elevation myocardial infarction (NSTEMI) with true bifurcation lesions [1,2]. OCT was applied before stent implantation, after rewiring, and to perform a final evaluation. The primary outcome measure was a composite of cardiac death, target-lesion myocardial infarction (MI), or ischaemia-driven target-lesion revascularisation at 2 years. Dr Lene Nyhus Andreasen (Aarhus University, Denmark) presented the primary results.

In the OCT-guided PCI arm, 10.1% of the participants had a major cardiovascular event, compared with 14.1% in the angiography-guided PCI arm,

thus meeting the primary endpoint (HR 0.70; 95% CI 0.50–0.98; P=0.035; see Figure). “The study was underpowered for the secondary outcomes, which were mainly the individual components of the primary outcome,” noted Dr Nyhus Andreasen. Cardiac death occurred in 1.4% and 2.6% of the participants in the experimental arm and the control arm, respectively (HR 0.53; 95% CI 0.22–1.25). Target-lesion MI was observed in 7.8% of the participants in the OCT-guided PCI arm and 8.5% of those in the angiography-guided PCI arm (HR 0.90; 95% CI 0.60–1.34). Ischaemia-driven target-lesion revascularisation was reported in 2.8% and 4.6% of the participants, numerically favouring the experimental arm (HR 0.60; 95% CI 0.32–1.13). Finally, the procedural safety did not differ between the 2 study arms.

Figure: Primary endpoint of major adverse cardiovascular events [1]



CI, confidence interval; OCT, optical coherence tomography; PCI, percutaneous coronary intervention.

1. 
   
   1. Nyhus Andreasen L, et al. OCTOBER: OCT or angiography guidance for PCI in complex bifurcation lesions. Hot Line Session 4, ESC Congress 2023, 25–28 August, Amsterdam, the Netherlands.
   2. Holm NR, et al. N Engl J Med 2023; Aug 27. DOI: 10.1056/NEJMoa2307770.

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Posted on 30 October 202323 April 2024