OCT-Defined Plaque Morphology and Clinical Outcomes After Percutaneous Coronary Intervention: An ILUMIEN IV Substudy
In brief
Calcific plaques double two-year target-vessel failure risk after PCI
In the ILUMIEN IV OCT cohort, patients whose lesions were predominantly calcific experienced target-vessel failure in 10.7% of cases versus 4.0% for fibrotic lesions, a roughly two-fold increase driven by more repeat revascularizations. Lipid-rich plaques showed intermediate event rates. The finding suggests OCT plaque typing may help identify patients at higher post-PCI risk, but prospective validation is needed.
- Journal
- JACC. Cardiovascular imaging (Q1)
- Published
- 1 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- John J Lopez, Rick H J A Volleberg, Doosup Shin, Emily Janak, Akiko Maehara, Fernando Alfonso, et al.
- PMID
- 42547197
- DOI
- 10.1016/j.jcmg.2026.05.015
Why clinicians should know about it
- Picked for Radiology, Radiation Oncology, Nuclear Medicine, Medical Physics and Imaging (top studies of the week, 9 August 2026): High-quality evidence in a top journal
- Picked for Geriatrics and Gerontology (top studies of the week, 9 August 2026).
Abstract
BACKGROUND: Optical coherence tomography (OCT) can differentiate plaque morphology (fibrous, lipidic, and calcified) within atherosclerotic lesions. The prognostic impact of predominant OCT plaque type after percutaneous coronary intervention (PCI) is unclear. OBJECTIVES: The aim of this study was to investigate clinical outcomes after PCI based on the preprocedural predominant plaque morphology from the OCT cohort of the ILUMIEN IV trial. METHODS: Subjects assigned to OCT guidance (n = 1,233) underwent core laboratory analysis to determine predominant lesion plaque morphology: lipidic (maximum arc ≥180° or thin-cap fibroatheroma), calcific (maximum arc ≥180°), or fibrotic. The primary endpoint was target-vessel failure (TVF), a composite of cardiac death, target-vessel myocardial infarction, or ischemia-driven target-vessel revascularization (ID-TVR). RESULTS: PCI of a single de novo lesion was performed in 926 patients. By OCT, the plaque was predominantly lipidic, calcific, and fibrotic in 309 (33%), 252 (27%), and 365 (39%) cases, respectively. After multivariable adjustment, patients undergoing PCI of a predominantly calcific lesion had increased rates of TVF (10.7% vs 4.0%; adjusted HR: 2.20 [95% CI: 1.12-4.33]; P = 0.02) driven by greater ID-TVR (8.2% vs 3.1%; adjusted HR: 2.31 [95% CI: 1.08-4.96]; P = 0.03) compared with PCI of a fibrotic lesion. Event rates in patients undergoing PCI of a predominantly lipidic lesion were intermediate (TVF 5.6% and ID-TVR 4.0%). CONCLUSIONS: Based on preprocedural OCT, PCI of calcific and fibrotic plaques was associated with the highest and lowest 2-year rates of TVF and ID-TVR, respectively, with lipidic plaques being of intermediate risk. This is the first report from a large-scale clinical trial that demonstrates the prognostic utility of baseline OCT plaque morphology on post-PCI outcomes. (ILUMIEN IV: OPTIMAL Percutaneous Coronary Intervention [PCI]; NCT03507777).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.