Optical Coherence Tomography Guided Percutaneous Coronary Intervention With Nobori Stent Implantation in Patients With Non–ST-Segment–Elevation Myocardial Infarction (OCTACS) Trial

Abstract

Background— Incomplete strut coverage has been documented an important histopathologic morphometric predictor for later thrombotic events. This study sought to investigate whether optical coherence tomography (OCT)–guided percutaneous coronary intervention with Nobori biolimus-eluting stent implantation in patients with non–ST-segment–elevation myocardial infarction would provide improved strut coverage at 6 months in comparison with angiographic guidance only. Methods and Results— One hundred patients were randomized 1:1 to either OCT-guided or angio-guided Nobori biolimus-eluting stent implantation. Postprocedure OCT was performed in all patients. In the OCT-guided group, prespecified criteria indicating additional intervention were related to (1) stent underexpansion, (2) strut malapposition, (3) edge dissection(s), and (4) residual stenosis at the distal or proximal reference segment(s). A final OCT was performed in case of reintervention. Six-month OCT follow-up was available in 85 patients. Twenty-three (46%) OCT-guided patients had additional postdilation or stenting. The percentage of acutely malapposed struts was substantially lower in the OCT-guided group (3.4% [interquartile range, 0.3–7.6] versus 7.8% [interquartile range, 2.3–19.4]; P <0.01). At 6-month follow-up, the OCT-guided group had a significantly lower proportion of uncovered struts; 4.3% [interquartile range, 1.2–9.8] versus 9.0% [interquartile range, 5.5–14.5], P <0.01. Furthermore, OCT-guided patients had significantly more completely covered stents: 17.5% versus 2.2%, P =0.02. The percentages of malapposed struts and struts being both uncovered and malapposed at follow-up were comparable between groups. Conclusions— OCT-guided optimization of Nobori biolimus-eluting stent implantation improves strut coverage at 6-month follow-up in comparison with angiographic guidance alone. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT02272283.