- Question
- Does optical coherence tomography (OCT)-guided PCI achieve better outcomes than angiography-guided PCI alone?
- Design
- Prospective, randomized, single-blind trial conducted at 80 sites in 18 countries, enrolling 2487 patients. In the angiography group, a final blinded OCT was performed to assess the stent result.
- Population
- Patients undergoing PCI with medication-treated diabetes or complex coronary lesions.
- Intervention
- OCT-guided PCI (1233 patients), with imaging before and after stent implantation following the protocol algorithm and a final OCT run.
- Control
- Angiography-guided PCI per local standard practice (1254 patients), with a blinded final OCT to document stent dimensions.
- Primary outcome
- Two primary efficacy end points: minimum stent area after PCI assessed by OCT, and target-vessel failure at 2 years (cardiac death, target-vessel myocardial infarction, or ischemia-driven target-vessel revascularization).
- Results
- Minimum stent area was 5.72±2.04 mm2 with OCT and 5.36±1.87 mm2 with angiography (mean difference 0.36 mm2; 95% CI 0.21 to 0.51; P<0.001). Target-vessel failure at 2 years was 7.4% vs 8.2% (HR 0.90; 95% CI 0.67 to 1.19; P = 0.45). Stent thrombosis within 2 years occurred in 6 patients (0.5%) with OCT and 17 (1.4%) with angiography.
- Safety
- OCT-related adverse events occurred in 1 patient in the OCT group and 2 in the angiography group.
- Conclusion
- OCT guidance produced a larger minimum stent area than angiography guidance, with no apparent between-group difference in target-vessel failure at 2 years.
- Why it matters
- It provided randomized evidence that optimizing stent results with intracoronary imaging is beneficial, although it did not show a reduction in overall clinical events for the primary end point.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 18, 2026