TCT CONNECT-410 Impact of Real-Time Optical Coherence Tomography-Angio Co-Registration (OCT-ACR) on Physician Decision Making During Percutaneous Coronary Intervention: A Multicenter, Prospective Study (iOPTICO study)

ABSTRACT

Background: The use of optical coherence tomography−angio co-registration (OCT-ACR) in routine clinical practice is evolving with limited reporting of clinical outcomes. We conducted this study to evaluate the impact of OCT-ACR on clinician decision making during percutaneous coronary intervention (PCI). Methods: Patients with clinically significant stenosis of >70% in at least 1 coronary artery were enrolled in the study. The pre- and post-PCI procedural strategies were prospectively assessed after angiography, OCT, and ACR with data analyzed by an independent core lab. We enrolled 500 patients from 9 centers in south Asia. Twenty-eight patients had inadequate imaging, whereas data from 75 patients are yet to be analyzed by core lab due to COVID-19. Results: The interim results included 397 patients with a mean age of 57.8 ± 10.8 years. Pre-procedural OCT resulted in a change in PCI strategy in 76% of lesions including change in stent length (57%), diameter (34%), strategy (10%), and landing zone (57%) (Figure). The use of ACR additionally altered treatment strategy in 23% lesions. Postprocedural OCT demonstrated edge dissections (3%), underexpansion (18%), malapposition (17%), tissue/thrombus prolapse (8%), and incomplete coverage (1%), thereby requiring additional interventions for optimization in 36% lesions. No change in strategy was observed with post-procedural ACR. [Formula presented] Conclusion: This is the first South Asian study reporting outcomes of OCT-ACR−guided PCI in patients with coronary artery disease. The use of OCT resulted in overall pre-procedural change of PCI strategy in 76% lesions compared with angiography. Real-time ACR had an additional significant impact with change in strategy in 23% of lesions. Categories IMAGING Imaging Intravascular