2049Standard and reduced doses of dabigatran, rivaroxaban, and apixaban for stroke prevention in atrial fibrillation: a nationwide cohort study

Background: Angiographic guidance for percutaneous coronary intervention (PCI) has substantial limitations. The superior spatial resolution of optical coherence tomography (OCT) could translate into meaningful clinical benefits, although limited data exist to date about their effect on clinical end points. We aimed to determine the effect on long-term survival of using OCT during percutaneous coronary intervention (PCI). Methods and results: This was a cohort study based on the Pan-London (United Kingdom) PCI registry. In total, 123,764 patients are included in this registry covering London, England, which includes all patients who underwent PCI in National Health Service hospitals in London between January 1, 2005, and May 31, 2015. Patients undergoing primary PCI or pressure wire use were excluded. The primary end point was all-cause mortality at a median of 4.1 years. OCT was used in 1149 patients (1.4%), IVUS was used in 19,971 patients (19.7%) and angiography alone in the remaining 66,149. Overall OCT rates increased over time (p<0.0001) with variation in rates between centres (p=0.002). The mean stent length was shortest in the angiography-guided group, longer in the IVUS guided group and longest in the OCT-guided group. OCT guided procedures were associated with greater procedural success rates and reduced inhospital MACE rates. A significant difference in mortality was observed between patients who underwent OCT-guided PCI (7.7%) compared with patients who underwent either IVUS (12.2%) or angiography guided PCI (15.7%, p<0.0001) (Figure Overall this difference persisted after multivariate cox analysis (HR 0.37 (95% CI 0.25-0.62) and propensity matching (HR=0.36, 95% CI: 0.18-0.73, p=0.0005) (OCT versus anigo alone cohort) with no difference in matched OCT and IVUS cohorts (HR 0.86 CI: 0.57-1.34).