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<p>Intravascular imaging for acute coronary syndrome is recommended in the guidelines; however, the actual rate of patients with ST-segment elevation myocardial infarction (STEMI) who successfully undergo optical coherence tomography (OCT)-guided primary percutaneous coronary intervention (PCI) is unclear. This study aimed to determine the feasibility of OCT-guided primary PCI and identify the patient population that would benefit most from OCT guidance in STEMI. The ATLAS-OCT trial was a prospective, single-arm, all-comers study conducted at 16 institutions. The primary endpoint was the feasibility of OCT guidance for primary PCI, defined as successful image acquisition (vessel’s circumferential or &gt; 270° visualization along &gt; 70% of the lesion’s length, as evaluated by an independent core laboratory). A total of 632 patients (mean age: 68.4&#xa0;years; 80.2% male) were enrolled in the study. OCT-guided PCI was performed in 503 patients, whereas OCT guidance was avoided in 129 patients for patient’s condition. Successful image acquisition was achieved in all but seven patients who underwent OCT. The primary endpoint was achieved in 78.5% (496/632) of patients. No procedural complications were associated with OCT. Patients with left main disease (adjusted odds ratio, 4.1; 95% confidence interval, 1.2–14.7; <i>p</i> = 0.024), estimated glomerular filtration rate (mL/min/1.73 m<sup>2</sup>) &lt; 30 (3.7; 1.6–8.3; <i>p</i> = 0.002), and Killip IV (2.5; 1.3–4.6; <i>p</i> = 0.003) were significantly avoided for OCT guidance. OCT guidance was feasible in four-fifths of all-comers with STEMI. Further studies are warranted to evaluate the efficacy of OCT-guided PCI in selected patient populations based on the findings of this trial (UMIN000048590).</p> Graphical abstract <p></p>

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Feasibility of optical coherence tomography-guided primary percutaneous coronary intervention for STEMI: all-comer ATLAS-OCT trial

  • 期刊论文

  • 发表日期：

    2025年5月30日

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  • Kohei Wakabayashi,
  • Taishi Yonetsu,
  • Takuya Mizukami,
  • Myong Hwa Yamamoto,
  • Sakiko Yasuhara,
  • Koki Shishido,
  • Shigeru Saito,
  • Nobuaki Kobayashi,
  • Masamichi Takano,
  • Eisuke Usui,
  • Tsunekazu Kakuta,
  • Yosuke Oishi,
  • Seita Kondo,
  • Tenjin Nishikura,
  • Yoshiyasu Minami,
  • Junya Ako,
  • Toshitaka Okabe,
  • Toru Naganuma,
  • Satoru Mitomo,
  • Sunao Nakamura,
  • Takumi Higuma,
  • Junya Shite,
  • Amane Kozuki,
  • Satoru Suwa,
  • Teruyoshi Kume,
  • Shiro Uemura,
  • Genki Naruse,
  • Hiroyuki Okura,
  • Yosuke Yamakami,
  • Hiroyuki Fujii,
  • Shigeki Kimura,
  • Masamichi Iwasaki,
  • Makoto Araki,
  • Tomoyo Sugiyama,
  • Mamoru Nanasato,
  • Tomotaka Dohi,
  • Takashi Ashikaga,
  • Hiroyoshi Mori,
  • Teruo Sekimoto,
  • Yoichiro Sugizaki,
  • Hiromasa Otake,
  • Toshiro Shinke

摘要

Intravascular imaging for acute coronary syndrome is recommended in the guidelines; however, the actual rate of patients with ST-segment elevation myocardial infarction (STEMI) who successfully undergo optical coherence tomography (OCT)-guided primary percutaneous coronary intervention (PCI) is unclear. This study aimed to determine the feasibility of OCT-guided primary PCI and identify the patient population that would benefit most from OCT guidance in STEMI. The ATLAS-OCT trial was a prospective, single-arm, all-comers study conducted at 16 institutions. The primary endpoint was the feasibility of OCT guidance for primary PCI, defined as successful image acquisition (vessel’s circumferential or > 270° visualization along > 70% of the lesion’s length, as evaluated by an independent core laboratory). A total of 632 patients (mean age: 68.4 years; 80.2% male) were enrolled in the study. OCT-guided PCI was performed in 503 patients, whereas OCT guidance was avoided in 129 patients for patient’s condition. Successful image acquisition was achieved in all but seven patients who underwent OCT. The primary endpoint was achieved in 78.5% (496/632) of patients. No procedural complications were associated with OCT. Patients with left main disease (adjusted odds ratio, 4.1; 95% confidence interval, 1.2–14.7; p = 0.024), estimated glomerular filtration rate (mL/min/1.73 m2) < 30 (3.7; 1.6–8.3; p = 0.002), and Killip IV (2.5; 1.3–4.6; p = 0.003) were significantly avoided for OCT guidance. OCT guidance was feasible in four-fifths of all-comers with STEMI. Further studies are warranted to evaluate the efficacy of OCT-guided PCI in selected patient populations based on the findings of this trial (UMIN000048590).

Graphical abstract