OCT is an emerging invasive coronary imaging. Literature underscores the impact of this technique in several clinical settings such as acute coronary syndromes (ACS) and percutaneous coronary intervention (PCI) guidance.

A recent single center study evaluated the trends and outcomes of OCT. The technique was found to have a good safety profile across a broad spectrum of patients encountered in daily practice. It was noted that minimal-lumen-area (MLA) could help stratify prognosis of patients undergoing OCT. The results from the study suggested that application of OCT in “real world” patients presenting higher risk has a good safety profile.

Another study reported on the safety of intracoronary Frequency Domain OCT (FD-OCT) imaging in a real world series of consecutive patients that underwent OCT during coronary catheterization. OCT was reported to be safe and feasible in unselected patients. Imaging related events were scarce, self-limiting or easily treatable, and transient.

Yet another study assessed whether frequency-domain OCT is safe and effective in the evaluation and treatment of angiographically-intermediate coronary lesions (ICL). Sixty-four patients with 2-D quantitative coronary angiography (2D-QCA) demonstrating ICL were included. OCT imaging was performed. The primary efficacy endpoint was to demonstrate the superiority and higher accuracy of frequency-domain OCT compared to 2D-QCA in evaluating stenosis severity in patients with ICL. The primary safety endpoint was the incidence of 30-d major adverse cardiac events (MACE). Analysis of the primary efficacy endpoint revealed that 2D-QCA overestimated the stenosis severity of ICL in both the OCT-guided PCI and OCT-guided optimal medical therapy (OMT) groups. OCT was thus shown to be superior to and more precise than 2D-QCA in treating this subset of lesions. The primary safety endpoint was fully met with the incidence of 30-d MACE being nil in both the OCT-guided PCI and OCT-guided OMT groups. OCT was shown to be safe and effective in the evaluation and treatment of ICL.

The CLI-OPCI registry also showed that OCT could potentially improve the clinical outcomes after coronary intervention in a real-world population. The 1-year composite of cardiac death or nonfatal MI was significantly lower in the OCT-guided intervention arm.