A clear-sighted view is what is needed in a rough sea

In this issue of EuroIntervention, Lee et al report on a subanalysis of the acute coronary syndrome (ACS) patients in the OCCUPI Trial12. OCCUPI, a 1,600-patient randomised controlled trial (RCT) from 2024, demonstrated a net clinical benefit of using an optical coherence tomography (OCT) over an angiography-only guided percutaneous coronary intervention (PCI) strategy in complex coronary artery disease (mainly long and bifurcation lesions). The results reinforced the most recent European Society of Cardiology guidelines, resulting in a Class I, Level of Evidence A recommendation on intracoronary (IC) imaging guidance for PCI in patients with complex coronary lesions3. Characteristic of a piece of robust, clinical, scientific work, the current analysis contributes important additional information to the existing knowledge and offers ideas for valuable future research in the field. First, in line with the overall findings of the OCCUPI Trial, the clinical benefit of OCT guidance in complex coronary lesions is shown to extend to patients with an ACS. ACS patients comprised just more than half of the total OCCUPI study population. Remarkably, the net clinical benefit of OCT...