Clinical Significance of Optical Coherence Tomography–Guided Percutaneous Coronary Intervention for In‐Stent Restenosis Within Drug‐Eluting Stents: Impact on Patient Outcomes

Background The evidence for optical coherence tomography (OCT)–guided percutaneous coronary intervention (PCI) in improving the prognosis of individuals with in‐stent restenosis (ISR) is lacking. Methods and Results This retrospective study enrolled 588 consecutive individuals with drug‐eluting stent ISR undergoing PCI from March 2010 to March 2022. Two hundred seven (35.2%) underwent OCT guidance, and 381 (64.8%) underwent angiography guidance. Clinical outcomes were analyzed using survival curves. The primary clinical endpoint was 2‐year major adverse cardiovascular events (MACEs), a composite of all‐cause death, myocardial infarction, and target‐vessel revascularization. Compared with angiography guidance, OCT guidance demonstrated a higher frequency of drug‐coated balloon use and adjunctive therapeutic modalities, including predilation, postdilation, nonslip element balloons, and noncompliant balloons ( P <0.05). Following PCI, the OCT‐guided group achieved a significantly larger minimum lumen diameter (2.36 versus 2.15 mm, P <0.001) and a lower percentage diameter stenosis (17% versus 20%, P <0.001) than the angiography‐guided group. Survival analysis revealed significantly lower 2‐year MACEs in the OCT‐guided group compared with the angiography‐guided group (7% versus 15%, P =0.007), validated in the propensity matching analysis (7% versus 15%, P =0.001). Multiple sensitivity analyses showed that OCT‐guided PCI treatment was an independent protective factor for 2‐year MACEs in individuals with drug‐eluting stent ISR. Conclusions Compared with angiography guidance, OCT guidance is associated with a lower 2‐year MACE risk among individuals with drug‐eluting stent ISR. Therefore, OCT should be actively considered for guiding PCI treatment in individuals with drug‐eluting stent ISR. Registration Url: clinicaltrials.gov . Identifier: NCT03809754.