OCT Improves Stent Optimization After Angiography-Guided PCI in OCCUPI Analysis

A prespecified analysis of the OCCUPI randomized trial examined how optical coherence tomography (OCT) contributes to stent optimization and whether assessment before stenting adds value. The first 200 consecutive patients in the trial’s OCT-guided arm were randomly assigned to full OCT-guided or angiography-first-guided percutaneous coronary intervention (PCI). Investigators assessed OCT-defined optimization after initially optimal stenting, then compared final optimization and one-year clinical outcomes after both groups received OCT-guided optimization.

The initial optimization rate was higher with full OCT guidance than with angiography-first guidance (63.3% versus 44.4%; P=0.012). Additional OCT-guided procedures increased the angiography-first group’s optimization rate to 60.6%, reducing maximal malapposition distance and resolving major edge dissections. Minimal stent area also increased but remained smaller than in the full OCT-guided group, which underwent OCT assessment before stenting.

These findings suggest that angiographically satisfactory stenting may leave abnormalities detectable by OCT, and that pre-stenting OCT may support greater stent expansion. However, one-year clinical outcomes did not differ between groups. The analysis included only 200 patients and primarily assessed imaging-defined optimization; the available abstract does not provide clinical event counts or precision estimates, limiting interpretation of clinical benefit.