A standardized optical coherence tomography workflow improves procedural efficiency and safety during percutaneous coronary intervention: insights from the LightLab Initiative
Transcatheter Cardiovascular Therapeutics 2021, November 4-6, 2021, Orlando, FL and Virtual
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Percutaneous coronary intervention (PCI) guided by intravascular imaging improves clinical outcomes and is endorsed by society guidelines. Nonetheless, routine intravascular imaging use remains low, partly because of a perceived lack of efficiency. The LightLab (LL) Program was designed to evaluate the impact of a standardized workflow (LL workflow) using optical coherence tomography (OCT) on PCI procedural efficiency.
Detailed PCI procedural data were collected over 2 years from 41 physicians at 16 US centers. OCT-guided PCI procedures incorporating the LL workflow (routine pre- and post-PCI OCT, n = 264) were compared with baseline angiography-guided PCI (n = 428). Propensity score analysis was used to control for differences between the groups, resulting in 207 matched subject pairs. Outcomes included procedure time, radiation exposure, contrast volume, device utilization, and treatment strategy.
Compared with angiography guidance alone, OCT-guided PCI with the LL workflow increased the median procedural time by 9 minutes but resulted in less radiation exposure and less time spent on vessel preparation (Table 1). In addition, fewer stents and balloons were used with OCT guidance, and there was a reduction in unplanned additional treatment over angiography-guided PCI. Furthermore, fewer angiographic views were required using the OCT-guided LL workflow, resulting in no difference in contrast utilization between groups. Outcomes Median (IQR) or % (n/N)Angiography Guided (n = 207)LL Workflow Guided (n = 207)P Value Procedure duration (minutes) 36 (24-55) 45 (34-64) <0.0001 Contrast volume (cc) 146 (113-187) 150 (120-195) 0.28 Radiation exposure (mGy) 1269 (779-1,930) 1,133 (711-1,743) 0.02 Cineangiography runs (# diagnostic views) 7 (3-9) 6 (3-8) <0.01 Stents (count) 1 (1-2) 1 (1-2) 0.0478 Compliant balloons (count) 1 (1 – 2) 1 (0 – 1) <0.0001 Lesions with unplanned additional treatment 10% (24/231) 4% (10/235) 0.01 Lesions with vessel prep 89% (212/238) 75% (179/239) <0.0001 Lesions with post-dilation 60% (138/231) 96% (218/227) <0.0001
The incorporation of a standardized workflow for OCT guidance during PCI improves multiple efficiency and safety metrics at a cost of a modestly longer procedure time. Overall, these data suggest that standardizing intravascular imaging workflow during PCI has the potential to improve PCI outcomes without substantially increasing procedure duration, which may result in greater adoption for routine PCI use.
Rauch, Judah; Johnson, Michael; Maksoud, Aziz; Spoon, Daniel; Zidar, Frank; Korngold, Ethan C; Buccola, Jana; Cabrera, Hector Garcia; Rapoza, Richard; West, Nick; and Osborn, Eric, "A standardized optical coherence tomography workflow improves procedural efficiency and safety during percutaneous coronary intervention: insights from the LightLab Initiative" (2021). Articles, Abstracts, and Reports. 5428.