OCCUPI Trial Evaluates OCT for Stent Guidance to Improve PCI Outcomes

September 9, 2024—The European Society of Cardiology (ESC) recently announced findings from the OCCUPI trial showing that the use of optical coherence tomography (OCT) to guide stent implantation during percutaneous coronary intervention (PCI) in patients with complex coronary lesions significantly improves survival and reduces adverse cardiovascular events compared to angiography-guided PCI.

The late-breaking research was presented in a Hot Line Session at the ESC Congress 2024 held August 30 to September 2 in London, United Kingdom.

According to ESC, the OCCUPI trial enrolled 1,604 patients (age, ≥ 19 years) from 20 centers in the Republic of Korea with anatomically complex lesions requiring PCI using drug-eluting stents. The study's lead investigator is Professor Byeong-Keuk Kim, MD, from Yonsei University Severance Hospital in Seoul, Korea.

Patients were randomized in a 1:1 ratio to undergo either OCT guidance (803 patients) or angiography guidance (801 patients). In total, 1,588 (99%) patients completed the 1-year follow-up.

The primary endpoint was a composite of cardiac death, myocardial infarction, stent thrombosis, and target-vessel revascularization at 1 year.

As summarized in the ESC press release, the OCCUPI investigators reported that at 1-year follow-up, patients who received OCT guidance experienced a 38% reduction in the combined risk of cardiac death, heart attacks, stent thrombosis, and the need for revascularization compared with angiography guidance (37 patients, 4.6% vs 59 patients, 7.4%, respectively).

Patients who received OCT guidance were 64% less likely to experience a spontaneous myocardial infarction (excluding periprocedural myocardial infarction) or require target-vessel revascularization than those in the angiography-guided group (0.9% vs 2.4% and 1.5% vs 4.1%, respectively).

The study also found that the incidence of contrast-induced nephropathy after PCI was not significantly different between the two groups (1.3% vs 0.9%).

“Our results show that the use of OCT guidance improves clinical outcomes and enhances the safety and effectiveness of coronary stenting, reducing cardiac death, myocardial infarction, stent thrombosis, and the need for revascularization by 38% in a group of very complex patients, which more reflects contemporary interventional cardiology practice,” commented Prof. Kim in the ESC press release.

As noted in the ESC press release, previous studies have suggested the practical benefits of OCT-guided PCI by providing comprehensive information on coronary vessels, plaques, and implanted stents.

According to ESC, this OCCUPI study follows up on findings of the OCTOBER trial showing that OCT-guided PCI of complex bifurcation lesions is superior to angiography-guided PCI for cardiovascular outcomes at 2 years. Niels R. Holm, MD, et al published the OCTOBER findings in The New England Journal of Medicine (2023;389:1477-1487). The study was also presented at the ESC Congress 2023 held August 25-28 in Amsterdam, the Netherlands.

“Our findings provide more evidence that OCT guidance of PCI procedures in patients with complex lesions has a greater impact on improving their lives than conventional angiography guidance,” concluded Professor Kim in the press release. “We now need to establish detailed standard for optimal use of OCT for the improvement of clinical outcomes of PCI for complex cases based on the OCCUPI trial.”