Cardiovascular revascularization medicine : including molecular interventions · 2023
Impact of IVUS and OCT on physician decision-making during post-PCI optimization.
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Bhogal Sukhdeep, Hashim Hayder, Merdler Ilan, Aladin Amer I, Zhang Cheng, Ben-Dor Itsik, Garcia-Garcia Hector M, Mintz Gary S, Waksman Ron
Аннотация
BACKGROUND: Intravascular imaging (IVI) has been available as a complementary diagnostic tool in addition to coronary angiography for more than two decades. Prior studies have suggested that IVI influences physician decision making in up to 27 % of cases during post-percutaneous coronary intervention (PCI) optimization. However, no studies have compared the two intracoronary imaging modalities (intravascular ultrasound [IVUS] vs. optical coherence tomography [OCT]) in shaping physician decisions post-PCI.
METHODS: We retrospectively analyzed IVI studies performed during PCI at a tertiary care center. IVUS and OCT cases performed by a single operator with expertise in both imaging studies were selected. The primary endpoint was the physician reaction rate during post-PCI optimization comparing IVUS vs. OCT.
RESULTS: A total of 142 patients underwent IVUS evaluation, and 146 underwent OCT evaluation, post-PCI. The primary endpoint did not differ between IVUS-guided vs OCT-guided PCI optimization (35.2 % vs. 31.5 %, p = 0.505). The predominant cause of abnormalities deemed unsatisfactory by the implanting physician warranting further intervention were stent under-expansion (26.1 % vs. 19.2 %, p = 0.163), followed by malapposition (2.1 % vs. 6.2 %, p = 0.085), and dissection (3.5 % vs 4.1 %, p = 0.794). Overall, IVI using either IVUS or OCT influenced the physician decision in 33.3 % of cases.
CONCLUSION: In this first study comparing IVUS- and OCT-guided PCI to assess their impact on physician decision making during post-PCI optimization, the primary endpoint of physician reaction rate was similar for IVUS vs. OCT. The use of post-PCI IVI changed physician management in one third of cases.
METHODS: We retrospectively analyzed IVI studies performed during PCI at a tertiary care center. IVUS and OCT cases performed by a single operator with expertise in both imaging studies were selected. The primary endpoint was the physician reaction rate during post-PCI optimization comparing IVUS vs. OCT.
RESULTS: A total of 142 patients underwent IVUS evaluation, and 146 underwent OCT evaluation, post-PCI. The primary endpoint did not differ between IVUS-guided vs OCT-guided PCI optimization (35.2 % vs. 31.5 %, p = 0.505). The predominant cause of abnormalities deemed unsatisfactory by the implanting physician warranting further intervention were stent under-expansion (26.1 % vs. 19.2 %, p = 0.163), followed by malapposition (2.1 % vs. 6.2 %, p = 0.085), and dissection (3.5 % vs 4.1 %, p = 0.794). Overall, IVI using either IVUS or OCT influenced the physician decision in 33.3 % of cases.
CONCLUSION: In this first study comparing IVUS- and OCT-guided PCI to assess their impact on physician decision making during post-PCI optimization, the primary endpoint of physician reaction rate was similar for IVUS vs. OCT. The use of post-PCI IVI changed physician management in one third of cases.