Impact of optical coherence tomography imaging on decision-making during percutaneous coronary intervention in patients presented with acute coronary syndromes

Background: Optical coherence tomography (OCT) provides valuable information to guide percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) regarding lesion preparation, stent sizing, and optimization. The aim of the present study was to compare lumen expansion of stent-treated lesions immediately after the procedure for ACS between OCT-guided PCI and angiography-guided PCI. Methods and Results: This study investigated stent-treated lesions immediately after PCI for ACS by using quantitative coronary angiography in 390 patients; 260 patients with OCT-guided PCI and 130 patients with angiography-guided PCI. Before stenting, the frequency of pre-dilatation and thrombus aspiration were not different between the OCT-guided and angiography-guided PCI groups. Stent diameter was significantly larger as a result of OCT-guided PCI (3.11?}0.44 mm vs. 2.99?}0.45 mm, P=0.011). In post-dilatation, balloon pressure-up (48% vs. 31%, P=0.001) and balloon diameter-up (33% vs. 6%, P<0.001) were more frequently performed in the OCT-guided PCI group. Minimum lumen diameter (2.55?}0.35 mm vs. 2.13?}0.50 mm, P<0.001) and acute lumen gain (2.18?}0.54 mm vs. 1.72?}0.63 mm, P<0.001) were significantly larger in the OCT-guided PCI group. Percent diameter stenosis (14?}4% vs. 24?}10%, P<0.001) and percent area stenosis (15?}5% vs. 35?}17%, P<0.001) were significantly smaller in the OCT-guided PCI group. Conclusions: OCT-guided PCI potentially results in larger lumen expansion of stent-treated lesions immediately after PCI in the treatment of ACS compared with angiography-guided PCI.