JACC. Cardiovascular interventions · 2026
Stenting Technique and Clinical Outcome in True Bifurcation PCI: Insights From the OCTOBER Trial.
СтатьяМногоцентровое исследованиеРандомизированное исследованиеСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Andreasen Lene Dohn, Holck Emil Nielsen, Neghabat Omeed, Laanmets Peep, Spratt James C, Santos-Pardo Irene, Jakobsen Lars, Ahtarovski Kiril Aleksov, Hune Mogensen Lone Juul, Bennett Johan, O'kane Peter, Cockburn James, Christiansen Evald Høj
Аннотация
BACKGROUND: Optimal stenting for true coronary bifurcation lesions is widely debated, with few studies using predefined intracoronary imaging.
OBJECTIVES: The aim of this study was to assess predictors and outcomes associated with a 1 vs a 2-stent technique and whether optical coherence tomographic (OCT) guidance modified the association with clinical outcomes.
METHODS: This OCTOBER (European Trial on Optical Coherence Tomography Optimized Bifurcation Event Reduction; NCT03171311) post hoc analysis included 1,201 patients with true coronary bifurcation treated with percutaneous coronary intervention (PCI). Clinical outcomes were analyzed using multivariable Cox regression. Multivariable logistic regression identified predictors of a 2-stent technique.
RESULTS: Clinical indication, left main coronary artery (LMCA) bifurcation, and side branch (SB) lesion severity were the strongest predictors of 2-stent use (acute clinical presentation: adjusted OR: 1.73 [95% CI: 1.33-2.25]; LMCA: adjusted OR: 2.04 [95% CI: 1.38-3.03]; SB lesion length: adjusted OR: 1.06 per mm [95% CI: 1.03-1.09]; SB diameter stenosis: adjusted OR: 1.04 per 1% [95% CI: 1.03-1.05]). In as-treated analysis, a 1-stent technique was associated with a lower 2-year rate of major adverse cardiac events (MACE) than a 2-stent technique (9.0% vs 13.9%; adjusted HR: 1.53; 95% CI: 1.04-2.27), with no interaction with OCT (P for interaction = 0.24). Planned-strategy analyses showed no significant difference in MACE. Among patients treated with a double kissing (DK)-crush technique, angiography-guided DK crush was associated with higher MACE rates compared with OCT-guided DK-crush (HR: 2.42; 95% CI: 1.12-5.24).
CONCLUSIONS: Clinical indication, LMCA bifurcation, and SB disease severity predicted 2-stent PCI. MACE did not differ according to planned strategy, whereas actual 2-stent PCI had higher MACE rates, likely reflecting a higher burden of complexity. The lowest event rates were observed with OCT-guided 1-stent PCI.
OBJECTIVES: The aim of this study was to assess predictors and outcomes associated with a 1 vs a 2-stent technique and whether optical coherence tomographic (OCT) guidance modified the association with clinical outcomes.
METHODS: This OCTOBER (European Trial on Optical Coherence Tomography Optimized Bifurcation Event Reduction; NCT03171311) post hoc analysis included 1,201 patients with true coronary bifurcation treated with percutaneous coronary intervention (PCI). Clinical outcomes were analyzed using multivariable Cox regression. Multivariable logistic regression identified predictors of a 2-stent technique.
RESULTS: Clinical indication, left main coronary artery (LMCA) bifurcation, and side branch (SB) lesion severity were the strongest predictors of 2-stent use (acute clinical presentation: adjusted OR: 1.73 [95% CI: 1.33-2.25]; LMCA: adjusted OR: 2.04 [95% CI: 1.38-3.03]; SB lesion length: adjusted OR: 1.06 per mm [95% CI: 1.03-1.09]; SB diameter stenosis: adjusted OR: 1.04 per 1% [95% CI: 1.03-1.05]). In as-treated analysis, a 1-stent technique was associated with a lower 2-year rate of major adverse cardiac events (MACE) than a 2-stent technique (9.0% vs 13.9%; adjusted HR: 1.53; 95% CI: 1.04-2.27), with no interaction with OCT (P for interaction = 0.24). Planned-strategy analyses showed no significant difference in MACE. Among patients treated with a double kissing (DK)-crush technique, angiography-guided DK crush was associated with higher MACE rates compared with OCT-guided DK-crush (HR: 2.42; 95% CI: 1.12-5.24).
CONCLUSIONS: Clinical indication, LMCA bifurcation, and SB disease severity predicted 2-stent PCI. MACE did not differ according to planned strategy, whereas actual 2-stent PCI had higher MACE rates, likely reflecting a higher burden of complexity. The lowest event rates were observed with OCT-guided 1-stent PCI.
Предметные рубрики MeSH
HumansTomography, Optical CoherenceCoronary Artery DiseaseFemaleTime FactorsTreatment OutcomeRisk FactorsMaleStentsPercutaneous Coronary InterventionPredictive Value of TestsAgedMiddle AgedSeverity of Illness IndexCoronary AngiographyOdds RatioMultivariate AnalysisCoronary VesselsEuropeProportional Hazards Models