Artificial Intelligence–Based Fully Automated Quantitative Coronary Angiography vs Optical Coherence Tomography–Guided PCI

BACKGROUND: Recently developed artificial intelligence-based coronary angiography (AI-QCA, fully automated) provides real-time, objective, and reproducible quantitative analysis of coronary angiography without requiring additional time or labor. OBJECTIVES: This study aimed to evaluate the efficacy of AI-QCA-assisted percutaneous coronary intervention (PCI) compared to optical coherence tomography (OCT)-guided PCI in terms of post-PCI results. METHODS: . RESULTS: in the OCT group (difference, -0.16; 95% CI: -0.59 to 0.28; P for noninferiority < 0.001). Other OCT-defined endpoints, such as stent underexpansion (50.8% [101/199] vs 54.6% [107/196]; P = 0.48), dissection (15.6% [31/199] vs 12.8% [25/196]; P = 0.42), and untreated reference segment disease (15.1% [30/199] vs 13.3% [26/196]; P = 0.61), were not significantly different between groups, except for a higher incidence of stent malapposition in the AI-QCA group (13.6% [27/199] vs 5.6 [11/196]; P = 0.007). CONCLUSIONS: This study demonstrated the noninferiority of AI-QCA-assisted PCI to OCT-guided PCI in achieving MSA with comparable OCT-defined endpoints. (Fully Automated Quantitative Coronary Angiography Versus Optical Coherence Tomography Guidance for Coronary Stent Implantation [FLASH]; NCT05388357).