Proportion and Clinical Impact of Stent Optimization During Imaging-Guided Percutaneous Coronary Intervention: The OCTIVUS Trial

Abstract

Background: Data regarding the proportion and clinical impact of achieving stent optimization by intravascular ultrasound (IVUS)– or optical coherence tomography (OCT)–guided percutaneous coronary intervention (PCI) remain limited.

Objectives: The authors assessed the proportion and cardiovascular outcomes in patients with and without stent optimization using imaging guidance.

Methods: This secondary analysis of the OCTIVUS (Optical Coherence Tomography-Guided or Intravascular Ultrasound-Guided Percutaneous Coronary Intervention) trial classified patients into optimized (meeting all prespecified optimization criteria) or nonoptimized groups. The primary endpoint was target vessel failure (TVF), a composite of cardiac death, target vessel myocardial infarction, or ischemia-driven target vessel revascularization.

Results: Among 1,980 patients, 1,022 (51.6%) achieved stent optimization, with a lower proportion in the OCT-guided group than in the IVUS-guided group (467 of 967 [48.3%] vs 555 of 1,013 [54.8%]; P = 0.004). At a median follow-up of 2.0 years, TVF incidence was lower in the optimized group than in the nonoptimized group (39 of 1022 [3.8%] vs 72 of 958 [7.5%]; HR: 0.52; 95% CI: 0.35-0.77; P < 0.001). The effect of stent optimization on TVF appeared more substantial in OCT-guided PCI (14 of 467 [3.0%] vs 38 of 500 [7.6%]; HR: 0.39; 95% CI: 0.21-0.72) than in IVUS-guided PCI (25 of 555 [4.5%] vs 34 of 458 [7.4%]; HR: 0.63; 95% CI: 0.37-1.05), albeit there was no significant interaction between TVF and imaging modalities (P for interaction = 0.30).

Conclusions: Stent optimization was achieved in approximately one-half of patients undergoing imaging-guided PCI and was associated with a better clinical outcome. This effect appeared more pronounced in OCT-guided than in IVUS-guided PCI. (Optical Coherence Tomography Versus Intravascular Ultrasound Guided Percutaneous Coronary Intervention [OCTIVUS]; NCT03394079)