{"id":"343dc974d249","type":"article","url":"https://hartvaat.nl/2016/09/27/oct-geleide-pci-optimalisatie-bij-nste-acs-gerandomiseerde-trial/","title":"OCT-geleide PCI-optimalisatie bij NSTE-ACS: gerandomiseerde trial","title_en":"Optical Coherence Tomography to Optimize Results of Percutaneous Coronary Intervention in Patients with Non-ST-Elevation Acute Coronary Syndrome: Results of the Multicenter, Randomized DOCTORS Study (Does Optical Coherence Tomography Optimize Results of Stenting).","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["intracoronaire-beeldvorming"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.024393","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.024393","authors":["Nicolas Meneveau","Geraud Souteyrand","Pascal Motreff","Christophe Caussin","Nicolas Amabile","Patrick Ohlmann","Olivier Morel","Yoann Lefrançois","Vincent Descotes-Genon","Johanne Silvain","Nassim Braik","Romain Chopard","Marion Chatot","Fiona Ecarnot","Hélène Tauzin","Eric Van Belle","Loïc Belle","François Schiele"],"significance":6,"published":"2016-09-27","source_date":"2016-09-27","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/","https://hartvaat.nl/kennis/cardiometabool/cardiometabool-spreekuur/"],"congress":"","summary_en":"This randomized trial showed that OCT-guided PCI optimization does not significantly improve clinical outcomes compared with angiography-guided PCI in NSTE-ACS patients, an early negative result for routine OCT guidance.","created":"2026-07-03T10:26:19Z","updated":"2026-07-03T13:25:39Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial die onderzocht of OCT (optical coherence tomography) de PCI-resultaten verbetert bij patiënten met NSTE-ACS. Onderzocht de meerwaarde van intracoronaire beeldvorming.","abstract_original":"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. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01743274."}