EROSION III: A Randomized Trial of OCT-Guided Intervention in STEMI Patients With Early Infarct Artery Patency
Reported from TCT 2021
Elad Asher reviews the EROSION III trial, presented by Haibo Jia, which studied whether OCT guidance compared with angiographic guidance only is associated with lower stent rate implantation during pPCI in STEMI patients with non-obstructive stenosis.
Rationale
The clinical rational of the study was to test whether the use of optical coherence tomography (OCT) guidance compared with angiographic guidance only is associated with lower stent rate implantation during primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) patients with non-obstructive stenosis (defined as diameter stenosis ≤ 70%).
How was the study preformed?
- Population and intervention:
- A Prospective, randomized, controlled, multi-center study of 226 patients (112 received OCT-guided intervention vs. 114 with angio-guided only).
- Inclusion criteria:
- Patients with STEMI <12h;
- De novo lesion;
- Angiographic diameter stenosis ≤ 70% by visual estimation;
- TIMI III flow after restoring antegrade flow.
- Exclusion criteria:
- Hemodynamic instability;
- Left main disease, ostial location or severely tortuous lesion precluding OCT imaging;
- Three-vessel disease;
- History of heart failure.
- Outcomes:
- OCT features included plaque rapture in 66% (of which 59% were stented vs. 41% who were not); plaque erosion 29% (of which 14% were stented vs. 86% who were not) and calcified nodules ~5% (of which 20% were stented vs. 80% who were not).
- The rate of stent implantation in the OCT-guided group was 43.8% compared with 58.8% in the angio-guided group (p=0.024). OCT guidance was associated with a 15% reduction of stent implantation when compared to angio guidance.
- Major adverse cardiovascular events (MACE) rate (cardiac death, recurrent MI, TLR, and unstable angina-induced rehospitalization) was similar in both groups (log-rank p=0.67).
- Time:
- Follow-up duration was 1-month and 1-year
Interpretation
The authors concluded that in selected STEMI, patients without obstructive stenosis, OCT guidance significantly reduced the rate of stent implantation during primary PCI and can be considered for decision-making in optimizing the reperfusion strategy. Nevertheless, the sample size was relatively small and the study was underpowered for clinical outcome assessment. More importantly, conservative strategy for treating plaque ruptures need more convinced data.
What is your approach regarding OCT guidance in STEMI patients with non-obstructive stenosis?
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