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Randomized Clinical Trial of OCT guided PCI and FFR

The DOCTORS (Does Optical Coherence Tomography Optimize Results of Stenting) study is a randomized clinical trial of OCT guided versus angiographically guided stent implantation in patients with Non-ST elevation acute coronary syndrome.
The primary end-point was post PCI Fractional Flow Reserve (FFR).

The supplement is available here. Dr Koitka has kindly provided an excellent presentation.

Abstract

BACKGROUND:
No randomized study has investigated the value of optical coherence tomography (OCT) in optimizing the results of percutaneous coronary intervention (PCI) for non–ST-segment elevation acute coronary syndromes.

METHODS:

We conducted a multicenter, randomized study involving 240 patients with non–ST-segment elevation acute coronary syndromes to compare OCT-guided PCI (use of OCT pre- and post-PCI; OCT-guided group) to fluoroscopy-guided PCI (angiography-guided group). The primary end point was the functional result of PCI assessed by the measure of post PCI fractional flow reserve. Secondary end points included procedural complications and type 4a periprocedural myocardial infarction. Safety was assessed by the rate of acute kidney injury.

RESULTS:

OCT use led to a change in procedural strategy in 50% of the patients in the OCT-guided group. The primary end point was improved in the OCT-guided group, with a significantly higher fractional flow reserve value (0.94±0.04 versus 0.92±0.05, P=0.005) compared with the angiography guided group. There was no significant difference in the rate of type 4a myocardial infarction (33% in the OCT-group versus 40% in the angiography guided group, P=0.28). The rates of procedural complications (5.8%) and acute kidney injury (1.6%) were identical in each group despite longer procedure time and use of more contrast medium in the OCT-guided group. Post-PCI OCT revealed stent underexpansion in 42% of patients, stent malapposition in 32%, incomplete lesion coverage in 20%, and edge dissection in 37.5%. This led to the more frequent use of poststent overdilation in the OCT-guided group versus the angiography-guided group (43% versus 12.5%, P<0.0001) with
lower residual stenosis (7.0±4.3% versus 8.7±6.3%, P=0.01).

CONCLUSIONS:

In patients with non–ST-segment elevation acute coronary syndromes, OCT-guided PCI is associated with higher postprocedure
fractional flow reserve than PCI guided by angiography alone. OCT did not increase periprocedural complications, type 4a myocardial infarction, or acute kidney injury.

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