title: Angiography alone versus angiography plus optical coherence tomography to guide decision-making during percutaneous coronary intervention: the Centro per la Lotta contro l'Infarto-Optimisation of Percutaneous Coronary Intervention (CLI-OPCI) study.
abstract: OBJECTIVE
  Angiographic guidance for percutaneous coronary intervention (PCI) has substantial limitations. The superior spatial resolution of optical coherence tomography (OCT) could translate into meaningful clinical benefits. We aimed to compare angiographic guidance alone versus angiographic plus OCT guidance for PCI.
  
  
  RESULTS
  Patients undergoing PCI with angiographic plus OCT guidance (OCT group) were compared with matched patients undergoing PCI with angiographic only guidance (Angio group) within 30 days. The primary endpoint was the one-year rate of cardiac death or myocardial infarction (MI). A total of 670 patients were included, 335 in the OCT group and 335 in the Angio group. OCT disclosed adverse features requiring further interventions in 34.7%. Unadjusted analyses showed that the OCT group had a significantly lower one-year risk of cardiac death (1.2% vs. 4.5%, p=0.010), cardiac death or MI (6.6% vs. 13.0%, p=0.006), and the composite of cardiac death, MI, or repeat revascularisation (9.6% vs. 14.8%, p=0.044). Angiographic plus OCT guidance was associated with a significantly lower risk of cardiac death or MI even at extensive multivariable analysis adjusting for baseline and procedural differences between the groups (OR=0.49 [0.25-0.96], p=0.037) and at propensity-score adjusted analyses.
  
  
  CONCLUSIONS
  This observational study, the first ever formally to appraise OCT guidance for PCI decision-making, suggests that the use of OCT can improve clinical outcomes of patients undergoing PCI.
authors.affiliation: Department of Interventional Cardiology, San Giovanni-Addolorata Hospital, IT-00184 Rome, Italy. fprati@hsangiovanni.roma.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Prati
authors.forename: Luca
authors.initials: L
authors.lastname: Di Vito
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.forename: Michele
authors.initials: M
authors.lastname: Occhipinti
authors.forename: Alessio
authors.initials: A
authors.lastname: La Manna
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.forename: Francesco
authors.initials: F
authors.lastname: Burzotta
authors.forename: Carlo
authors.initials: C
authors.lastname: Trani
authors.forename: Italo
authors.initials: I
authors.lastname: Porto
authors.forename: Vito
authors.initials: V
authors.lastname: Ramazzotti
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Imola
authors.forename: Alessandro
authors.initials: A
authors.lastname: Manzoli
authors.forename: Laura
authors.initials: L
authors.lastname: Materia
authors.forename: Alberto
authors.initials: A
authors.lastname: Cremonesi
authors.forename: Mario
authors.initials: M
authors.lastname: Albertucci
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D011237:Predictive Value of Tests; D057216:Propensity Score; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome