Abbott’s research demonstrates enhanced stent performance in heart disease patients

MedTech & Diagnostics News: Cutting-edge research conducted by Abbott and presented at the ESC Congress 2023 has shed light on the promising potential of Optical Coherence Tomography (OCT)-guided percutaneous coronary intervention (PCI). These studies unveil important insights into cardiovascular care, revealing both enhanced stent performance and a transformative reduction in stent thrombosis.

Abbott’s ILUMIEN IV trial was designed to investigate whether OCT-guided PCI would triumph over its angiography-guided counterpart. The trial, spanning across 80 sites in 18 countries and encompassed patients with medication-treated diabetes and complex coronary lesions.

With a participant cohort of 2,487 individuals, the OCT-guided group showed a substantial increase in the minimum stent area achieved, a fact that captured the attention of the surgical community.

Dr Ziad Ali from St Francis Hospital, Roslyn, USA, and a key author of the study, shared his insights, saying “OCT-guided PCI led to a larger minimum stent area, enhanced the safety of the PCI procedure and resulted in a nearly two-thirds reduction in stent thrombosis during two-year follow-up. However, in this trial OCT guidance did not reduce the two-year rate of target vessel failure compared with angiography-guided PCI because of a low and nearly identical rate of target vessel revascularisation in the OCT-guided and angiography-guided PCI arms.”

Safety was also profoundly impacted by OCT guidance, as evidenced by the notable reduction in angiographic complications. The benefits extended beyond mere stent dimensions, with OCT guidance demonstrating a notable decrease in cases of major dissection, malapposition, tissue protrusion, and untreated reference segment disease. Moreover, stent thrombosis within two years was diminished in the OCT-guided group, standing at 0.5%, compared to 1.4% in the angiography-guided cohort.

Additionally, Abbott’s OCTIVUS trial also presented at ESC was a head-to-head comparison of OCT- and intravascular ultrasound (IVUS)-guided PCI with regards to clinical outcomes in patients with a broad range of coronary artery lesions.

The OCT group showcased superior outcomes with a 2.5% occurrence rate of cardiovascular death, target vessel myocardial infarction, or ischemia-driven target vessel revascularisation compared to 3.1% in the IVUS group (p < 0.001).

In line with evolving guidelines, both in Europe and the United States, the research highlights the consideration of IVUS or OCT in select patients to optimise stent implantation. This pivotal investigation has lifted the veil on the comparative effectiveness of these innovative strategies.

The principal investigator of the study, Professor Duk-Woo Park from Asan Medical Centre, Seoul, Republic of Korea, shared his perspective. He said “Among patients undergoing PCI for diverse coronary artery lesions, OCT-guided PCI was noninferior to IVUS-guided PCI with respect to a composite of death from cardiac causes, target vessel myocardial infarction, or ischemia-driven target vessel revascularisation at 12 months after the index procedure. The primary results of OCTIVUS add compelling evidence on the relative efficacy and safety of an OCT-guided strategy compared with an IVUS-guided strategy for PCI.”

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