Proportion and Clinical Impact of Stent Optimization During Imaging-Guided Percutaneous Coronary Intervention The OCTIVUS Trial

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. OBJECTIVES The authors 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 nonoptimized 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 the OCT-guided group than in the 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 nonoptimized group (39 of 1022 [3.8%] vs 72 of 958 [7.5%]; HR: 0.52; 95% CI: 0.35-0.77; P < 0.001). The effect of stent optimization on TVF appeared more substantial in OCT-guided PCI (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 there was no significant interaction between TVF and imaging modalities (P for interaction = 0.30). CONCLUSIONS Stent optimization was achieved in approximately one-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. (Optical Coherence Tomography Versus Intravascular Ultrasound Guided Percutaneous Coronary Intervention [OCTIVUS]; NCT03394079) (c) 2025 by the American College of Cardiology Foundation.