Clinical Impact of Optical Coherence Tomography-Guided Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction　― A Substudy of the TACTICS Registry ―

Abstract

Background: Optical coherence tomography (OCT) has the potential to reduce clinical events more effectively than angiography alone, but its penetration rate, clinical utility, and clinical impacts in ST-elevation myocardial infarction (STEMI) remain unknown. We aimed to clarify the relationship between OCT-defined morphology, acute results of primary percutaneous coronary intervention (PCI), and clinical outcomes at 1 year in patients with STEMI.

Methods and Results: This post hoc analysis of the TACTICS registry investigated patients with STEMI who underwent OCT-guided primary PCI. Major adverse cardiovascular events (MACE) were defined as a composite of cardiovascular death, myocardial infarction, heart failure, or ischemia-driven revascularization. Of 1,046 patients with STEMI, 441 (42.2%) underwent OCT-guided PCI. The prevalence of plaque rupture (PR), plaque erosion (PE), and calcified nodule (CN) was 299 (68.3%), 106 (24.2%), and 16 (3.7%), respectively. The cumulative MACE rate was highest in patients with CN (31.2%), followed by those with PR (14.0%) and PE (2.8%; log-rank P<0.0001). Multivariate Cox regression analysis identified CN as the strongest independent predictor of MACE at 1 year (hazard ratio [HR] 8.25; 95% confidence interval [CI] 1.70–40.10; P=0.009), followed by PR (HR 4.82; 95% CI 1.48–15.68; P=0.009).

Conclusions: OCT-guided PCI was performed with a high penetration rate of approximately 40% in patients with STEMI. Lesion morphology may serve as a key predictor of future cardiovascular events.