Improving efficiency and operator proficiency during percutaneous coronary interventions utilizing a standardized optical coherence tomography workflow. Journal Article

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Authors: Khuddus, MA; Darki, A; Padaliya, BB; West, NEJ; Rapoza, RJ; Buccola, J; Amis, G; Chehab, BM; Secemsky, EA
Article Title: Improving efficiency and operator proficiency during percutaneous coronary interventions utilizing a standardized optical coherence tomography workflow.
Abstract: OBJECTIVES: This study was designed to compare efficiency and quality metrics between percutaneous coronary intervention (PCI) procedures using optical coherence tomography (OCT) guided by a variable workflow versus a standardized workflow in a real-world population. BACKGROUND: The LightLab (LL) Initiative was designed to evaluate the impact of a standardized OCT workflow during PCI to address barriers to adoption. METHODS: The LL Initiative was a multicenter, prospective, observational study. PCI efficiency data were collected from 1/21/19 to 1/8/21 from 45 physicians at 17 US centers. OCT-guided PCIs were compared between baseline phase (variable workflow; N?=?383) and the LL workflow utilization phase (N?=?447). The LL workflow uses OCT to assess lesion Morphology, Length and Diameter, and then optimize outcomes by correcting for Medial dissection, stent mal-Apposition, and under-eXpansion (MLD MAX). Matching based on propensity scores was used to control for differences between PCIs. RESULTS: After propensity matching, 291 paired procedures were included. Integration of the LL versus variable workflow resulted in no difference in procedure time (51?min vs. 51?min, p?=?0.93). There was a reduction in radiation exposure (1124?mGy vs. 1493?mGy, p?0.0001) and contrast volume (160?cc vs. 172?cc, p?0.001). The LL workflow decreased the proportion of underexpanded lesions (34% vs. 54%, p?0.0001) and improved minimum stent expansion (85% vs. 79%, p?0.0001). Number of noncompliant balloons used was reduced with the LL workflow. (2.0 vs. 1.7, p?0.01). CONCLUSIONS: These data suggest that standardizing imaging with the LL workflow may overcome barriers to imaging and improve PCI outcomes without prolonging procedures.
Journal Title: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography Interventions
ISSN: 1522-726X; 1522-1946
Publisher: Unknown  
Date Published: 2022