title: Optical Coherence Tomography-Guided Percutaneous Coronary Intervention in ST-Segment-Elevation Myocardial Infarction: A Prospective Propensity-Matched Cohort of the Thrombectomy Versus Percutaneous Coronary Intervention Alone Trial.
abstract: BACKGROUND
  Patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment-elevation myocardial infarction are at increased risk for adverse events. It is unclear if image guidance by optical coherence tomography (OCT) can improve outcomes in these patients. We compared OCT-guided versus angiography-guided primary PCI for ST-segment-elevation myocardial infarction among patients in the Thrombectomy Versus PCI Alone (TOTAL) trial.
  
  
  RESULTS
  Among 10 732 patients enrolled in the TOTAL trial, OCT was used for PCI guidance as a part of a prospective substudy in 214 patients. Using 2:1 propensity matching, we identified 428 patients in the trial who had PCI performed with angiography guidance alone. The primary outcome was a composite of cardiovascular death, myocardial infarction, stent thrombosis, and target-vessel revascularization at 1 year. Secondary outcomes included final in-stent angiographic minimum lumen diameter, procedure time, and contrast dose. The final in-stent angiographic minimum lumen diameter was 2.99±0.48 mm in the OCT-guided group versus 2.79±0.47 mm in the angiography-guided group (P<0.0001). OCT- and angiography-guided PCI had a median (interquartile range) procedure time of 58 (47, 71) minute versus 38 (28, 52) minute (P<0.0001) and total contrast dose of 239.7±81.1 mL versus 193.3±78.6 mL (P<0.0001). The primary outcome was observed in 7.5% of the OCT-guided group versus 9.8% of the angiography-guided group (hazard ratio, 0.76; 95% confidence interval, 0.43-1.34; P=0.34).
  
  
  CONCLUSIONS
  OCT-guided primary PCI for ST-segment-elevation myocardial infarction was associated with a larger final in-stent minimum lumen diameter. There was no significant difference in clinical outcomes at 1 year; however, the study was underpowered to detect a treatment effect.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT01149044.
authors.affiliation: From the Population Health Research Institute, McMaster University and Hamilton Health Science, Hamilton, Canada (T.N.S., M.K.N., O.S., R.T., B.M., S.S.J.); Heart Hospital, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland (O.A.K., K.N.); London Health Sciences Centre, London, Canada (S.L.); Royal North Shore Hospital, Sydney, Australia (R.B.), Southlake Regional Health Centre, University of Toronto, Newmarket, Canada (W.J.C.); St. Michael's Hospital, Toronto, Canada (A.N.C.); and Clinical Center of Serbia, Belgrade, Serbia (G.S.). shetht@mcmaster.ca.
authors.forename: Tej N
authors.initials: TN
authors.lastname: Sheth
authors.affiliation: From the Population Health Research Institute, McMaster University and Hamilton Health Science, Hamilton, Canada (T.N.S., M.K.N., O.S., R.T., B.M., S.S.J.); Heart Hospital, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland (O.A.K., K.N.); London Health Sciences Centre, London, Canada (S.L.); Royal North Shore Hospital, Sydney, Australia (R.B.), Southlake Regional Health Centre, University of Toronto, Newmarket, Canada (W.J.C.); St. Michael's Hospital, Toronto, Canada (A.N.C.); and Clinical Center of Serbia, Belgrade, Serbia (G.S.).
authors.forename: Olli A
authors.initials: OA
authors.lastname: Kajander
authors.affiliation: From the Population Health Research Institute, McMaster University and Hamilton Health Science, Hamilton, Canada (T.N.S., M.K.N., O.S., R.T., B.M., S.S.J.); Heart Hospital, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland (O.A.K., K.N.); London Health Sciences Centre, London, Canada (S.L.); Royal North Shore Hospital, Sydney, Australia (R.B.), Southlake Regional Health Centre, University of Toronto, Newmarket, Canada (W.J.C.); St. Michael's Hospital, Toronto, Canada (A.N.C.); and Clinical Center of Serbia, Belgrade, Serbia (G.S.).
authors.forename: Shahar
authors.initials: S
authors.lastname: Lavi
authors.affiliation: From the Population Health Research Institute, McMaster University and Hamilton Health Science, Hamilton, Canada (T.N.S., M.K.N., O.S., R.T., B.M., S.S.J.); Heart Hospital, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland (O.A.K., K.N.); London Health Sciences Centre, London, Canada (S.L.); Royal North Shore Hospital, Sydney, Australia (R.B.), Southlake Regional Health Centre, University of Toronto, Newmarket, Canada (W.J.C.); St. Michael's Hospital, Toronto, Canada (A.N.C.); and Clinical Center of Serbia, Belgrade, Serbia (G.S.).
authors.forename: Ravinay
authors.initials: R
authors.lastname: Bhindi
authors.affiliation: From the Population Health Research Institute, McMaster University and Hamilton Health Science, Hamilton, Canada (T.N.S., M.K.N., O.S., R.T., B.M., S.S.J.); Heart Hospital, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland (O.A.K., K.N.); London Health Sciences Centre, London, Canada (S.L.); Royal North Shore Hospital, Sydney, Australia (R.B.), Southlake Regional Health Centre, University of Toronto, Newmarket, Canada (W.J.C.); St. Michael's Hospital, Toronto, Canada (A.N.C.); and Clinical Center of Serbia, Belgrade, Serbia (G.S.).
authors.forename: Warren J
authors.initials: WJ
authors.lastname: Cantor
authors.affiliation: From the Population Health Research Institute, McMaster University and Hamilton Health Science, Hamilton, Canada (T.N.S., M.K.N., O.S., R.T., B.M., S.S.J.); Heart Hospital, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland (O.A.K., K.N.); London Health Sciences Centre, London, Canada (S.L.); Royal North Shore Hospital, Sydney, Australia (R.B.), Southlake Regional Health Centre, University of Toronto, Newmarket, Canada (W.J.C.); St. Michael's Hospital, Toronto, Canada (A.N.C.); and Clinical Center of Serbia, Belgrade, Serbia (G.S.).
authors.forename: Asim N
authors.initials: AN
authors.lastname: Cheema
authors.affiliation: From the Population Health Research Institute, McMaster University and Hamilton Health Science, Hamilton, Canada (T.N.S., M.K.N., O.S., R.T., B.M., S.S.J.); Heart Hospital, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland (O.A.K., K.N.); London Health Sciences Centre, London, Canada (S.L.); Royal North Shore Hospital, Sydney, Australia (R.B.), Southlake Regional Health Centre, University of Toronto, Newmarket, Canada (W.J.C.); St. Michael's Hospital, Toronto, Canada (A.N.C.); and Clinical Center of Serbia, Belgrade, Serbia (G.S.).
authors.forename: Goran
authors.initials: G
authors.lastname: Stankovic
authors.affiliation: From the Population Health Research Institute, McMaster University and Hamilton Health Science, Hamilton, Canada (T.N.S., M.K.N., O.S., R.T., B.M., S.S.J.); Heart Hospital, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland (O.A.K., K.N.); London Health Sciences Centre, London, Canada (S.L.); Royal North Shore Hospital, Sydney, Australia (R.B.), Southlake Regional Health Centre, University of Toronto, Newmarket, Canada (W.J.C.); St. Michael's Hospital, Toronto, Canada (A.N.C.); and Clinical Center of Serbia, Belgrade, Serbia (G.S.).
authors.forename: Kari
authors.initials: K
authors.lastname: Niemelä
authors.affiliation: From the Population Health Research Institute, McMaster University and Hamilton Health Science, Hamilton, Canada (T.N.S., M.K.N., O.S., R.T., B.M., S.S.J.); Heart Hospital, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland (O.A.K., K.N.); London Health Sciences Centre, London, Canada (S.L.); Royal North Shore Hospital, Sydney, Australia (R.B.), Southlake Regional Health Centre, University of Toronto, Newmarket, Canada (W.J.C.); St. Michael's Hospital, Toronto, Canada (A.N.C.); and Clinical Center of Serbia, Belgrade, Serbia (G.S.).
authors.forename: Madhu K
authors.initials: MK
authors.lastname: Natarajan
authors.affiliation: From the Population Health Research Institute, McMaster University and Hamilton Health Science, Hamilton, Canada (T.N.S., M.K.N., O.S., R.T., B.M., S.S.J.); Heart Hospital, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland (O.A.K., K.N.); London Health Sciences Centre, London, Canada (S.L.); Royal North Shore Hospital, Sydney, Australia (R.B.), Southlake Regional Health Centre, University of Toronto, Newmarket, Canada (W.J.C.); St. Michael's Hospital, Toronto, Canada (A.N.C.); and Clinical Center of Serbia, Belgrade, Serbia (G.S.).
authors.forename: Olga
authors.initials: O
authors.lastname: Shestakovska
authors.affiliation: From the Population Health Research Institute, McMaster University and Hamilton Health Science, Hamilton, Canada (T.N.S., M.K.N., O.S., R.T., B.M., S.S.J.); Heart Hospital, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland (O.A.K., K.N.); London Health Sciences Centre, London, Canada (S.L.); Royal North Shore Hospital, Sydney, Australia (R.B.), Southlake Regional Health Centre, University of Toronto, Newmarket, Canada (W.J.C.); St. Michael's Hospital, Toronto, Canada (A.N.C.); and Clinical Center of Serbia, Belgrade, Serbia (G.S.).
authors.forename: Rachel
authors.initials: R
authors.lastname: Tittarelli
authors.affiliation: From the Population Health Research Institute, McMaster University and Hamilton Health Science, Hamilton, Canada (T.N.S., M.K.N., O.S., R.T., B.M., S.S.J.); Heart Hospital, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland (O.A.K., K.N.); London Health Sciences Centre, London, Canada (S.L.); Royal North Shore Hospital, Sydney, Australia (R.B.), Southlake Regional Health Centre, University of Toronto, Newmarket, Canada (W.J.C.); St. Michael's Hospital, Toronto, Canada (A.N.C.); and Clinical Center of Serbia, Belgrade, Serbia (G.S.).
authors.forename: Brandi
authors.initials: B
authors.lastname: Meeks
authors.affiliation: From the Population Health Research Institute, McMaster University and Hamilton Health Science, Hamilton, Canada (T.N.S., M.K.N., O.S., R.T., B.M., S.S.J.); Heart Hospital, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland (O.A.K., K.N.); London Health Sciences Centre, London, Canada (S.L.); Royal North Shore Hospital, Sydney, Australia (R.B.), Southlake Regional Health Centre, University of Toronto, Newmarket, Canada (W.J.C.); St. Michael's Hospital, Toronto, Canada (A.N.C.); and Clinical Center of Serbia, Belgrade, Serbia (G.S.).
authors.forename: Sanjit S
authors.initials: SS
authors.lastname: Jolly
mesh_terms: D016009:Chi-Square Distribution; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D011237:Predictive Value of Tests; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011829:Radiation Dosage; D012307:Risk Factors; D017131:Thrombectomy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome
keywords: myocardial infarction; optical coherence tomography; percutaneous coronary intervention; thrombectomy