Optical coherence tomography (OCT) guidance during PCI resulted in a lower incidence of major adverse cardiac events at one year in patients requiring drug-eluting stent (DES) implantation for complex lesions, compared with angiography guidance, based on findings from the OCCUPI trial presented at ESC Congress 2024 in London and simultaneously published in The Lancet.

Researchers randomized 1,604 patients from 20 hospitals in South Korea to either OCT-guided PCI (n=803) or angiography-guided PCI (n=801). The median age of participants was 64 and 20% were women.

The primary endpoint of major adverse cardiac events at one year occurred in 37 patients (5%) in the OCT-guided PCI group – a 38% reduction – compared with 59 patients (7%) in the angiography-guided PCI group. According to the researchers, rates of stroke, bleeding events and contrast-induced nephropathy were not significantly different across the two groups. However, they noted that patients receiving OCT guidance were 64% less likely to experience a spontaneous myocardial infarction or require target-vessel revascularization than those receiving angiography-guidance.

"Our findings provide more evidence that OCT guidance of PCI procedures in patients with complex lesions has a greater impact on improving their lives than conventional angiography guidance," said lead investigator Byeong-Keuk Kim, MD, PhD. "We now need to establish detailed standard for optimal use of OCT for the improvement of clinical outcomes of PCI for complex cases based on the OCCUPI trial."