Optimization Process After Angiography-Guided Stent Implantation: Pre-specified Analysis of the OCCUPI Randomized Trial
In brief
Optical coherence tomography raises stent optimization from 44% to 63%
Among 200 patients, full optical coherence tomography guidance met stent optimization criteria in 63.3%, compared with 44.4% after angiography-first stenting. Adding OCT optimization in the angiography-first group raised its rate to 60.6%, but stent expansion remained less than with OCT before stenting; one-year clinical outcomes did not differ, leaving the clinical advantage uncertain.
- Journal
- European heart journal. Cardiovascular Imaging (Q1)
- Published
- 29 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Sang-Hyup Lee, Yong-Joon Lee, Seung-Jun Lee, Chul-Min Ahn, Jung-Sun Kim, Young-Guk Ko, et al.
- PMID
- 42806467
- DOI
- 10.1093/ehjci/jeag276
Why clinicians should know about it
- Picked for Cardiology and Cardiovascular Medicine (top studies of the week, 4 October 2026): OCT-guided PCI improves stent optimization
Abstract
AIMS: Despite its benefits, the detailed process by which optical coherence tomography (OCT) improves stent optimization, and the role of pre-stenting OCT assessment, have not been fully investigated. We aimed (1) to assess the achievement of OCT-defined optimization criteria after angiography-guided stent implantation, and (2) to assess the role of pre-stenting OCT assessment. METHODS AND RESULTS: The first consecutive 200 patients in the OCT-guided arm of the OCCUPI trial were randomly assigned to the full OCT-guided or angiography-first-guided group. In the angiography-first-guided group, after achieving angiographically optimal stenting, OCT was performed to compare the achievement of OCT-defined optimization criteria between full OCT-guided PCI and angiography-first-guided PCI. After additional procedures in the angiography-first-guided group, the stent optimization rates and 1-year clinical outcomes were compared between the full OCT-guided and angiography-first-guided groups, both of which underwent stent optimization using OCT. The optimization rate was higher in the full OCT-guided group than in the angiography-first-guided group (63.3% vs. 44.4%; P = 0.012). After optimization with OCT, the optimization rate in the angiography-first-guided group increased to 60.6% with decrease of maximal malapposition distance and resolution of major edge dissections. Although the minimal stent area (MSA) increased after optimization with OCT in the angiography-first-guided group (MSA of OCT guidance without pre-stenting OCT), it remained smaller than that of the full OCT-guided group (MSA of OCT guidance with pre-stenting OCT). The clinical outcomes did not differ between groups. CONCLUSION: Angiography guidance achieved a lower optimization rate than OCT guidance. Furthermore, pre-stenting OCT may facilitate more robust stent expansion. STUDY REGISTRATION: ClinicalTrials.gov (ID: NCT03625908).
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.