Background: Data regarding the proportion and clinical impact of achieving stent optimization by intravascular ultrasound (IVUS)- or optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) remain limited.
Objective: We assessed the proportion and cardiovascular outcomes in patients with and without stent optimization using imaging guidance.
Methods: This secondary analysis of the OCTIVUS (Optical Coherence Tomography-Guided or Intravascular Ultrasound-Guided Percutaneous Coronary Intervention) trial classified patients into optimized (meeting all prespecified optimization criteria) or non-optimized groups. The primary endpoint was target-vessel failure (TVF), a composite of cardiac death, target-vessel myocardial infarction, or ischemia-driven target-vessel revascularization.
Results: Among 1,980 patients, 1,022 (51.6%) achieved stent optimization, with a lower proportion in OCT-guided than in IVUS-guided group (467 of 967 [48.3%] vs. 555 of 1,013 [54.8%], P=0.004). At a median follow-up of 2.0 years, TVF incidence was lower in the optimized group than in the non-optimized group (39 of 1022 [3.8%] vs. 72 of 958 [7.5%]; hazard ratio [HR]: 0.52; 95% confidence interval [CI]: 0.35-0.77; P<0.001). The effect of stent optimization on TVF appeared more substantial in OCT-guided (14 of 467 [3.0%] vs. 38 of 500 [7.6%]; HR: 0.39; 95% CI: 0.21-0.72) than in IVUS-guided PCI (25 of 555 [4.5%] vs. 34 of 458 [7.4%]; HR: 0.63; 95% CI: 0.37-1.05), albeit no significant interaction between TVF and imaging modalities (P-for-interaction=0.30).
Conclusions: Stent optimization was achieved in approximately half of patients undergoing imaging-guided PCI and was associated with a better clinical outcome. This effect appeared more pronounced in OCT-guided than in IVUS-guided PCI.
Editors
Editor-in-Chief
Harlan M. Krumholz, MD, SM, FACC
CME Editor
Ragavendra R. Baliga, MD
Author
Hoyum Kim, MD
Duk-Woo Park, MD
Important Dates
Date of Release: May 12, 2025
Term of Approval/Date of CME/MOC Expiration: May 11, 2026