The latest European guidelines recommend intracoronary imaging (ICI) guidance by intravascular ultrasound (IVUS) or optical coherence tomography (OCT) for percutaneous coronary intervention (PCI) on anatomically complex lesions, particularly for left main stem, true bifurcations, and long lesions1. However, large-scale randomised studies comparing the efficacy between ICI-guided and angiography-guided PCI in patients with acute coronary syndrome (ACS) remain limited. In patients with non-ST-segment elevation ACS, OCT-guided PCI has been associated with a higher post-PCI fractional flow reserve compared to angiography guidance, providing detailed information on lesion characteristics and stent expansion2. Performing OCT-guided PCI in acute settings poses significant challenges due to the need for blood clearance, which may lead to complications such as slow flow, dissection, and distal embolisation3. We investigated whether OCT offers comparable clinical efficacy and safety to IVUS for patients with and without ACS in an all-comers PCI population.
In this post hoc analysis of the OCTIVUS trial with extended 2-year follow-up, we evaluated the outcomes of OCT versus IVUS guidance for PCI in ACS and non-ACS patients, building upon the initial 1-year non-inferiority findings4....
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