OCCUPI: OCT-guided PCI improves outcomes in complex CAD

Patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation for complex lesions benefitted from an optical coherence tomography (OCT)-guided procedure compared with an angiography-guided procedure in terms of major adverse cardiovascular events (MACE).

“Anatomically complex coronary artery disease (CAD) still presents challenges, despite the advancements that have been made with PCI plus DES,” said Prof. Byeong-Keuk Kim (Yonsei University Hospital, South Korea) [1]. The OCCUPI trial (NCT03625908) aimed to assess the possible clinical benefits of OCT for patients with complex lesions. This multicentre, open-label, randomised trial included 1,604 participants with complex coronary lesions, who were allocated to the OCT-guided PCI arm or the angiography-guided PCI arm [1,2]. The primary endpoint was MACE at 1 year of follow-up.

The primary endpoint favoured the OCT-guided arm, with a lower event rate in this arm than in the control arm (4.6% vs 7.4%; HR 0.62; 95% CI 0.41–0.93; P=0.023) [1]. Looking at the individual components of this endpoint, Prof. Kim and co-investigators found that the occurrence of spontaneous myocardial infarction (MI; 0.9% vs 2.4%), target-vessel related MI (0.6% vs 2.1%), and target vessel revascularisation (1.5% vs 4.1%) were all significantly in favour of the OCT-guided arm. “Patients meeting all the criteria of stent optimisation in the OCT-guided arm were less likely to experience MACE than patients who did not meet all 3 criteria,” added Prof. Kim (2.9% vs 8.6%; HR 0.33; 95% CI 0.17–0.65; P=0.001).

“The findings of the OCCUPI trial support the therapeutic benefit of OCT as an effective intravascular imaging modality in treating complex lesions,” concluded Prof. Kim.

1. 
   
   1. Kim B-K, et al. Optical coherence tomography-guided coronary intervention in patients with complex lesions: the OCCUPI randomised clinical trial. HOTLINE 11, ESC Congress 2024, 30 Aug–02 Sept, London, UK.

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Posted on 7 November 20247 November 2024