Better Is the Evolution of Good: How IVUS and OCT Have Transformed PCI

Abstract

Purpose of Review

We seek to provide a focused appraisal of the most recent outcomes data for intravascular ultrasound (IVUS) and optical coherence tomography (OCT).

Recent Findings

There are multiple randomized control trials and meta-analyses investigating the effects of these two intravascular imaging (IVI) modalities on clinical decision-making and long-term clinical outcomes in percutaneous coronary intervention (PCI). While the effects of IVUS have been studied for decades, OCT is a newer form of IVI with less experience and data on its use in clinical practice.

Summary

IVUS-guided PCI has beneficial effects on mortality, stent thrombosis, target lesion/target vessel revascularization, and major adverse cardiac events when compared to angiography alone. While less data exists for OCT-guided PCI, early studies suggest it is at least non-inferior to IVUS for many of the same outcomes. However, future investigations should focus on how clinical outcomes are changed by these two IVI modalities when compared head-to-head.

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Abbreviations

ACCF:

American College of Cardiology Foundation

AHA:

American Heart Association

BMS:

Bare metal stent

CTO:

Chronic total occlusion

DES:

Drug-eluting stent

IVI:

Intravascular imaging

IVUS:

Intravascular ultrasound

MA:

Meta-analysis

MACE:

Major adverse cardiac events

MI:

Myocardial infarction

OCT:

Optical coherence tomography

PCI:

Percutaneous coronary intervention

RCT:

Randomized control trial

SCAI:

Society for Cardiovascular Angiography and Interventions

ST:

Stent thrombosis

STEMI:

ST-elevation myocardial infarction

TLR:

Target lesion revascularization

TVF:

Target vessel failure

TVR:

Target vessel revascularization

•:

Important reference

••:

Very important reference

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Correspondence to Adhir Shroff.

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Dr. Simon has nothing to disclose. Dr. Rodriguez Ziccardi has nothing to disclose. Ms. Dickens has nothing to disclose. Dr. Young has nothing to disclose. Dr. Shroff has nothing to disclose with relation to this manuscript.

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Simon, E.J., Ziccardi, M.R., Dickens, H. et al. Better Is the Evolution of Good: How IVUS and OCT Have Transformed PCI. Curr Cardiovasc Imaging Rep 13, 24 (2020). https://doi.org/10.1007/s12410-020-09544-0

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Keywords

  • Clinical outcomes
  • Coronary angiography
  • Drug eluting stent
  • Intravascular imaging
  • Intravascular ultrasound
  • Optical coherence tomography
  • Optical frequency domain
  • Percutaneous coronary intervention