الفهرس 
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Abstract
This thesis aimed to compare lumen expansion of stent-treated lesions immediately after the procedure in ACS patients between OCT-guided PCI and angiography-guided PCI using quantitative coronary angiography, assess procedural changes caused by OCT use compared with angiography alone and assess its’ impact on clinical outcomes. The study analyzed data of 390 patients underwent primary PCI for treatment of ACS, including STEMI and NSTE-ACS in the period between 2009 and 2018, 130 patients was treated with angiography guidance alone, and 260 patients were treated with OCT guidance. Procedural details, acute results including in stent lumen expansion immediately after intervention, procedural changes and clinical outcomes at 1 year were compared between both groups. OCT guidance resulted in using larger (3.11 ± 0.44 mm vs. 2.99 ± 0.45 mm, p = 0.011), longer stents (24 ± 9 mm vs. 21 ± 9 mm, p = 0.013) and less frequently usage of additional stent (8% vs. 19%, p = 0.001) compared to angiography guidance. OCT usage led to more frequent use of post dilatation (64% vs. 52%, p = 0.016), with larger balloons (3.26 ± 0.49 mm vs. 3.04 ± 0.48 mm, p < 0.001) and higher pressure (16 ± 5 atm vs. 14 ± 5 atm, p < 0.001) compared to angiography guidance. OCT usage led to procedural change compared with angiography guidance in form of using more frequent balloon pressure up (26% vs. 15%, p = 0.020) and balloon diameter up (33% vs. 15%, p < 0.001) pre stenting. Also post stenting, OCT guidance resulted in more frequent balloon pressure up (48% vs. 31%, p = 0.001) and balloon diameter up (33% vs. 6%, p <0.001) compared to angiography guidance. Immediately after intervention, OCT guidance resulted in larger minimum lumen diameter (2.55 ± 0.35 mm vs. 2.13 ± 0.50 mm, p < 0.001), larger acute lumen gain (2.18 ± 0.54 mm vs. 1.72 ± 0.63 mm, p < 0.001), smaller residual percent diameter stenosis (14 ± 4% vs. 24 ± 10%, p < 0.001) and smaller residual percent area stenosis (15 ± 5% vs. 35 ± 17%, p < 0.001) compared with angiography guidance. Those favorable acute results with OCT guidance were translated into less frequent MACE at 1-year follow up in OCT guidance group compared with angiography guidance (5% vs 12%, p = 0.02) HR (95%CI) 0.41 (0.20-0.87). Regarding safety; contrast media volume used, incidence of CIN development and peri-procedural stroke were not different between both groups. In this retrospective analysis, OCT-guided PCI was associated with larger lumen expansion of stent-treated lesions immediately after PCI in ACS patients compared with angiography-guided PCI. These data warrant a large scale randomized trial to establish whether or not OCT-guided PCI results in superior clinical outcomes compared to angiography-guided PCI. OCT guidance is recommended for better understanding the underlying etiology and mechanism of ACS development. OCT guidance is recommended for optimizing results of intervention in ACS patients and improving clinical outcomes. Further prospective studies are needed to validate the superiority of OCT guidance intervention compared to angiography guidance alone. Further prospective studies are needed to set OCT criteria for post-dilatation, thrombus aspiration and distal protection to prevent no-reflow and/or distal embolization.