Role Of OCT In Percutaneous Coronary Intervention For STEMI Patients With Multivessel Coronary Artery Disease

Objectives: To assess the role of OCT in PCI for non-IRA in PCI in acute STEMI patients with MVD.Methods: We selected 38 STEMI patients with MVD accepting emergency PCI within 12 hours in our hospital from July 2014 to July 2015,and randomly divided into the OCT guiding group or no OCT guiding group.There were 16 cases in the OCT guiding group and 22 cases in the other group.The former accepted examination of OCT 7-10 days later.If the plaque was vulnerable plague,it would accept PCI treatment.The latter would accept PCI treatment if the luminal stenosis of the non-IRA was greater than or equal to 70%.The primary endpoint was all-cause mortality in 6 months.Secondary endpoints were cardiac death,nonfatal myocardial infarction,re-intervention,recurrent angina,rehospitalization from cardiac causes.Results: 1)In the 38 patients,there were 31 male and 7 female.The average age was 60.57.Table 1 shows the baseline clinical characteristics of patients in each group.There was no significant difference between the two groups.Table 2 shows the coronary artery stenosis of patients in each group.There was no significant difference between the two groups;2)There was no significant difference in the rate of stent implantation for non-IRA between the two groups(75.00%vs72.23%,P=0.548);the rate of stent implantation for non-IRA(the stenosis?70%)was decreased obviously in the OCT guiding group compared with no OCT guiding group(77.78%vs100%,P=0.030);the rate of stent implantation for non-IRA(50% ? the stenosis < 70%)was increased obviously in the OCT guiding group compared with no OCT guiding group(66.67%vs0%,P=0.008);3)Compared with no OCT guiding group,the dosage of contrast agent was increased obviously in the OCT guiding group(320.00±65.82vs246.36±82.72,P=0.002);4)There was no significant difference between the two groups in the primary endpoint,cardiac death,nonfatal myocardial infarction,rehospitalization from cardiac causes.Compared with no OCT guiding group,the re-intervention(0vs6,P=0.030)and recurrent angina(1vs9,P=0.025)were obviously reduced in the OCT guiding group.Conclusions: We can accurately obtain the fibrous cap thickness,morphology change of lumen and vessel wall,including lumen size,vascular dissection,thrombus,macrophage infiltration by applying OCT.Then we can identify vulnerable plaque,reduce the occurrence of re-intervention and recurrent angina for the STEMI patients with multivessel in coronary artery interventional therapy.