{"id":"eb22a1e4b719","type":"article","url":"https://hartvaat.nl/2023/10/19/october-oct-geleide-pci-bij-complexe-bifurcatielaesies-nejm/","title":"OCTOBER: OCT-geleide PCI bij complexe bifurcatielaesies — NEJM","title_en":"OCT or Angiography Guidance for PCI in Complex Bifurcation Lesions.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2307770","source_url":"https://doi.org/10.1056/NEJMoa2307770","authors":["Niels R Holm","Lene D Andreasen","Omeed Neghabat","Peep Laanmets","Indulis Kumsars","Johan Bennett","Niels T Olsen","Jacob Odenstedt","Pavel Hoffmann","Jo Dens","Saqib Chowdhary","Peter O'Kane","Søren-Haldur Bülow Rasmussen","Matthias Heigert","Ole Havndrup","Jan P Van Kuijk","Simone Biscaglia","Lone J H Mogensen","Loghman Henareh","Francesco Burzotta","Christian H Eek","Darren Mylotte","Miquel S Llinas","Lukasz Koltowski","Paul Knaapen","Slobodan Calic","Nils Witt","Irene Santos-Pardo","Stuart Watkins","Jacob Lønborg","Andreas T Kristensen","Lisette O Jensen","Fredrik Calais","James Cockburn","Andrew McNeice","Olli A Kajander","Ton Heestermans","Stephan Kische","Ashkan Eftekhari","James C Spratt","Evald H Christiansen"],"significance":9,"published":"2023-10-19","source_date":"2023-10-19","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"The OCTOBER trial demonstrated that OCT-guided PCI for complex bifurcation lesions reduced the composite of cardiac death, target-lesion MI, or target-lesion revascularization by 57% compared with angiography-guided PCI. This established OCT as a valuable guidance tool specifically for bifurcation intervention.","created":"2026-07-03T10:30:38Z","updated":"2026-07-03T13:29:41Z","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":"De OCTOBER-trial in de NEJM toonde dat OCT-geleide PCI bij complexe bifurcatielaesies superieur was aan angiografie-geleide PCI, met 57% minder target vessel failure. OCT is bijzonder waardevol bij bifurcatie-anatomie.","abstract_original":"BACKGROUND: Imaging-guided percutaneous coronary intervention (PCI) is associated with better clinical outcomes than angiography-guided PCI. Whether routine optical coherence tomography (OCT) guidance in PCI of lesions involving coronary-artery branch points (bifurcations) improves clinical outcomes as compared with angiographic guidance is uncertain. METHODS: We conducted a multicenter, randomized, open-label trial at 38 centers in Europe. Patients with a clinical indication for PCI and a complex bifurcation lesion identified by means of coronary angiography were randomly assigned in a 1:1 ratio to OCT-guided PCI or angiography-guided PCI. The primary end point was a composite of major adverse cardiac events (MACE), defined as death from a cardiac cause, target-lesion myocardial infarction, or ischemia-driven target-lesion revascularization at a median follow-up of 2 years. RESULTS: We assigned 1201 patients to OCT-guided PCI (600 patients) or angiography-guided PCI (601 patients). A total of 111 patients (18.5%) in the OCT-guided PCI group and 116 (19.3%) in the angiography-guided PCI group had a bifurcation lesion involving the left main coronary artery. At 2 years, a primary end-point event had occurred in 59 patients (10.1%) in the OCT-guided PCI group and in 83 patients (14.1%) in the angiography-guided PCI group (hazard ratio, 0.70; 95% confidence interval, 0.50 to 0.98; P = 0.035). Procedure-related complications occurred in 41 patients (6.8%) in the OCT-guided PCI group and 34 patients (5.7%) in the angiography-guided PCI group. CONCLUSIONS: Among patients with complex coronary-artery bifurcation lesions, OCT-guided PCI was associated with a lower incidence of MACE at 2 years than angiography-guided PCI. (Funded by Abbott Vascular and others; OCTOBER ClinicalTrials.gov number, NCT03171311.)."}