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<p>The OCCUPI trial demonstrated the clinical benefit of optical coherence tomography (OCT)–guided percutaneous coronary intervention (PCI). However, whether the effect of OCT guidance differs according to diseased coronary vessel remains unclear. This prespecified substudy evaluated the consistency of clinical outcomes with OCT-guided PCI in left anterior descending (LAD) versus non-LAD lesions. Among 1,375 patients without left main disease, 888 had LAD lesions and 487 had non-LAD lesions. Patients were randomized to undergo PCI guided by either OCT or conventional angiography. The primary endpoint was 1-year major adverse cardiovascular events (MACE), defined as a composite of cardiac death, myocardial infarction, stent thrombosis, or ischemia-driven target-vessel revascularization (TVR). Outcomes were assessed by time-to-event analysis. In the LAD group, 1-year MACE occurred in 4.5% of patients treated with OCT-guided PCI and 5.5% treated with angiography-guided PCI, with no statistically significant difference (<i>p</i> = 0.456). In the non-LAD group, corresponding MACE rates were 4.6% and 7.7%, respectively (<i>p</i> = 0.099). There was no significant interaction between diseased vessel and PCI guidance strategy (<i>p</i> for interaction = 0.351). Ischemia-driven TVR occurred less frequently with OCT-guided PCI in both LAD and non-LAD lesions, without significant heterogeneity (p for interaction = 0.872). In complex coronary lesions, the clinical effect of OCT-guided PCI was consistent between LAD and non-LAD vessels, with fewer repeat revascularizations observed across diseased-vessel subgroups.</p> Graphical abstract <p>Clinical Outcomes According to Treatment Strategy Among 1,375 OCCUPI patients without left main disease, 1-year MACE did not significantly differ across OCT- vs angiography-guided PCI in LAD and non-LAD lesions (log-rank p = 0.229).</p>

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Optical coherence tomography–guided PCI in left anterior descending versus non–left anterior descending lesions: a prespecified substudy of the OCCUPI trial

  • 期刊论文

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  • 发表日期：

    2026年5月29日

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  • Soo-Jin Kim,
  • Seung-Jun Lee,
  • Sung-Jin Hong,
  • Sang-Hyup Lee,
  • Jong-Young Lee,
  • Deok-Kyu Cho,
  • Jin Won Kim,
  • Sang Min Kim,
  • Seung-Ho Hur,
  • Ji-Yong Jang,
  • Jin Sin Koh,
  • Hoyoun Won,
  • Jun-Won Lee,
  • Soon Jun Hong,
  • Dong-Kie Kim,
  • Jeong Cheon Choe,
  • Jin Bae Lee,
  • Tae-Hyun Yang,
  • Jung-Hee Lee,
  • Young Joon Hong,
  • Jong-Hwa Ahn,
  • Yong-Joon Lee,
  • Chul-Min Ahn,
  • Jung-Sun Kim,
  • Young-Guk Ko,
  • Donghoon Choi,
  • Myeong-Ki Hong,
  • Yangsoo Jang,
  • Jung Ho Heo,
  • Byeong-Keuk Kim

摘要

The OCCUPI trial demonstrated the clinical benefit of optical coherence tomography (OCT)–guided percutaneous coronary intervention (PCI). However, whether the effect of OCT guidance differs according to diseased coronary vessel remains unclear. This prespecified substudy evaluated the consistency of clinical outcomes with OCT-guided PCI in left anterior descending (LAD) versus non-LAD lesions. Among 1,375 patients without left main disease, 888 had LAD lesions and 487 had non-LAD lesions. Patients were randomized to undergo PCI guided by either OCT or conventional angiography. The primary endpoint was 1-year major adverse cardiovascular events (MACE), defined as a composite of cardiac death, myocardial infarction, stent thrombosis, or ischemia-driven target-vessel revascularization (TVR). Outcomes were assessed by time-to-event analysis. In the LAD group, 1-year MACE occurred in 4.5% of patients treated with OCT-guided PCI and 5.5% treated with angiography-guided PCI, with no statistically significant difference (p = 0.456). In the non-LAD group, corresponding MACE rates were 4.6% and 7.7%, respectively (p = 0.099). There was no significant interaction between diseased vessel and PCI guidance strategy (p for interaction = 0.351). Ischemia-driven TVR occurred less frequently with OCT-guided PCI in both LAD and non-LAD lesions, without significant heterogeneity (p for interaction = 0.872). In complex coronary lesions, the clinical effect of OCT-guided PCI was consistent between LAD and non-LAD vessels, with fewer repeat revascularizations observed across diseased-vessel subgroups.

Graphical abstract

Clinical Outcomes According to Treatment Strategy Among 1,375 OCCUPI patients without left main disease, 1-year MACE did not significantly differ across OCT- vs angiography-guided PCI in LAD and non-LAD lesions (log-rank p = 0.229).