Achieving optimal stent placement during heart procedures significantly improves patient outcomes, according to a new study. Findings show that only about half of patients receiving imaging-guided percutaneous coronary intervention (PCI) achieve full stent optimization, but those who do experience better results. “This effect appeared more pronounced in optical coherence tomography (OCT) -guided than in intravascular ultrasound (IVUS) -guided PCI,” noted the research team in their manuscript published in JACC: Cardiovascular Interventions. PCI procedure Led by Hoyun Kim, MD, from the University of Ulsan College of Medicine in Seoul, Korea, the research team examined 1,980 patients who underwent PCI guided by either OCT or IVUS. Patients whose stents were fully optimized had a 48% lower risk of target vessel failure (TVF), a combination of cardiac death, heart attack or the need for repeat procedures, over a median follow-up of two years. Further findings revealed that TVF occurred in just 3.8% of patients with optimized stents compared to 7.5% in those without full optimization. The benefit was particularly strong among those guided by OCT imaging, where TVF rates dropped from 7.6% in the non-optimized group to 3.0% in the optimized group. Subgroup analysis Commenting on the trial’s limitations, the team acknowledged that the study was a subgroup analysis of the OCTIVUS trial and thus may have been statistically underpowered to detect clinically relevant findings. Therefore, the findings of the present study should be interpreted as being hypothesis generating, they said. In conclusion, the team suggested that improved protocols and more uniform criteria for stent optimization could enhance outcomes even further. They also called for future research to refine the techniques and thresholds used during imaging-guided interventions. Methodology The Optical Coherence Tomography-Guided or Intravascular Ultrasound-Guided Percutaneous Coronary Intervention (OCTIVUS) trial enrolled 2,008 patients with significant coronary artery disease (CAD), who were randomly assigned in a 1:1 ratio to undergo PCI guided either by optical coherence tomography (OCT) or intravascular ultrasound (IVUS). Eligible patients were 19 years or older and undergoing PCI with either drug-eluting stents (DES) or drug-coated balloons (for cases of in-stent restenosis). The primary endpoint was target vessel failure (TVF), defined as a composite of cardiac death, target vessel-related myocardial infarction, or ischemia-driven target vessel revascularization. Source: Kim H, Kang DY, Ahn JM, et al. Proportion and Clinical Impact of Stent Optimization During Imaging-Guided Percutaneous Coronary Intervention: The OCTIVUS Trial. JACC Cardiovasc Interv 2025 April 28 (Article in Press). Image Credit: Chinnapong – stock.adobe.com