Intravascular Ultrasound versus Optical Coherence Tomography in Guiding Percutaneous Coronary Intervention for Patients with Unstable Angina:A Comparative Study on Efficacy

HU Yonghui; LIN Jiancai; ZHENG Wuyang; ZHAO Xiliang

doi:10.13919/j.issn.2095-6274.ZHJY202507002

Abstract：Objective To compare and analyze the clinical application value of intravascular ultrasound(IVUS)versus optical coherence tomography(OCT)in guiding percutaneous coronary intervention(PCI)in pa-tients with unstable angina(UA).Methods A total of 162 UA patients who underwent PCI in our hospital from September 2022 to March 2025 were selected and randomly assigned to either the IVUS group(n=81)or the OCT group(n=81)using a random number table.The following parameters were compared between the two groups:pro-cedure-related indicators(procedure time,contrast agent volume,number of stents implanted,hospital stay),stent implantation outcomes(stent expansion index,malap-position,tissue prolapse,edge dissection),post-proce-dural myocardial injury markers(peak CK-MB,peak cTnI and their time to normalization),and the incidence of in-hospital major adverse cardiovascular events(MACE).Cox regression analysis was used to identi-fy independent influencing factors for MACE.Re-suits Compared to the IVUS group,the OCT group had significantly shorter procedure time,less contrast agent usage,fewer stents implanted,and a shorter hospital stay(all P＜0.01).Regarding stent implantation outcomes,the stent expansion index was significantly higher in the OCT group(P＜0.001),while the incidences of stent malappo-sition(4.9％vs.14.8％,P=0.035),tissue prolapse(3.7％vs.18.5％,P=0.007),and edge dissection(3.7％vs.12.3％,P=0.043)were all significantly lower.Simultaneously,patients in the OCT group exhibited lower peak levels of CK-MB and cTnI and shorter times to normalization(all P＜0.001).Furthermore,the total incidence of in-hospital MACE was significantly lower in the OCT group than in the IVUS group(3.70％vs.12.35％,P=0.043).Multi-variate Cox regression analysis identified OCT guidance as an independent protective factor against MACE risk(HR=0.281,95％CI:0.090～0.881,P=0.029).Younger age(HR=1.879,95％CI:1.289～2.739,P=0.001)and better cardiac function(HR=0.565,95％CI:0.362～0.882,P=0.012)were also associated with a significantly reduced risk of major endpoint events.Conclusion In PCI for UA patients,compared to IVUS guidance,OCT guidance sig-nificantly improves procedural efficiency,optimizes stent implantation quality,reduces myocardial injury,and,to-gether with younger age and better cardiac function,serves as an independent protective factor against MACE risk,leading to improved short-term prognosis and demonstrating superior clinical application value.