Optical Coherence Tomography versus Intravascular Ultrasound-Guided Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction: A Multicenter Propensity-Matched Analysis.

Current guidelines recommend intravascular imaging guidance for percutaneous coronary intervention (PCI). While both optical coherence tomography (OCT) and intravascular ultrasound (IVUS) are endorsed, comparative data in STEMI remain limited. To compare clinical outcomes between OCT and IVUS guidance for primary PCI for ST-elevation myocardial infarction (STEMI). From a multicenter registry of 2,777 consecutive STEMI patients undergoing primary PCI within 24 hours from onset at 12 Japanese hospitals, we analyzed 2,291 patients who received OCT-guided (n = 244, 10.7%) or IVUS-guided (n = 2,047, 89.3%) PCI. The primary endpoint was target vessel-related major adverse cardiac events (TV-MACE): cardiovascular death, target vessel revascularization, and target vessel-related myocardial infarction. Propensity score matching was performed to adjust for baseline differences. During median follow-up of 722 days, TV-MACE rates tended to be lower in the OCT group in unmatched analysis (9.8% vs 14.5%; p = 0.051). After propensity matching (187 pairs), this difference disappeared (8.6% vs 10.2%; p = 0.723). Kaplan-Meier analysis showed no significant differences for TV-MACE (hazard ratio [HR] 0.82, 95% confidence interval [95% CI] 0.42 to 1.59, p = 0.552), cardiovascular death (HR 0.46, 95% CI 0.16 to 1.32, p = 0.150), or target vessel revascularization (HR 1.07, 95% CI 0.43 to 2.63, p = 0.891). OCT guidance was associated with more frequent procedures without stenting (12.8% vs 5.3%, p = 0.027) and fewer stents per patient (0.99 ± 0.52 vs 1.15 ± 0.56, p = 0.006). In conclusion, OCT-guided PCI demonstrated comparable outcomes to IVUS-guided PCI in STEMI patients, supporting the use of either imaging modality for primary PCI. Condensed abstract: This multicenter registry compared optical coherence tomography (OCT) versus intravascular ultrasound (IVUS) guidance for primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI). Clinical outcomes were compared between the patients undergoing OCT-guided PCI (n = 244) and those with IVUS-guided PCI (n = 2,047). After propensity score matching (187 pairs), target vessel-related major adverse cardiac events rates were similar between OCT and IVUS groups (8.6% vs 10.2%, p = 0.723) during median 722-day follow-up. No significant differences were observed in cardiovascular death or target vessel revascularization. OCT guidance was associated with more frequent procedures without stenting and fewer stents per patient. Both imaging modalities demonstrated comparable clinical outcomes.