What happened
OCT-guided PCI proves noninferior to IVUS-guided PCI for target lesion failure.
Why the trial, tables, limitations, PICO, abstract, media & sources
Intravascular imaging improves outcomes of left main PCI, but IVUS and OCT had never been compared head-to-head for guiding treatment of distal left main bifurcation lesions, where vessel size and ostial assessment challenge each modality differently.
Does OCT-guided PCI reduce target lesion failure compared to IVUS-guided PCI in patients with true distal left main bifurcation lesions?
| Outcome | OCT | IVUS |
|---|---|---|
| Target lesion failure at 12 months Primary composite (Kaplan-Meier) · adjusted HR 0.90 (95% CI 0.59-1.36); noninferior (p=0.0003), superiority not established | OCT 14.4% | IVUS 19.6% |
Does OCT-guided PCI reduce target lesion failure compared to IVUS-guided PCI in patients with true distal left main bifurcation lesions?
OCT-guided PCI is noninferior to IVUS-guided PCI with respect to 12-month target lesion failure in patients undergoing intervention for true distal left main bifurcation lesions.
OCT offers a viable alternative to IVUS for left main bifurcation PCI; extends randomized evidence for intravascular guidance in this anatomy.
ISOLEDS was an open-label noninferiority trial that enrolled 664 patients with true distal left main bifurcation lesions at 24 centres in China and randomised them 1:1 to OCT- or IVUS-guided PCI. Mean age was 63.5 years and 22.1% were women. The 12-month primary endpoint was target lesion failure (cardiac death, target-lesion-related myocardial infarction, or clinically driven target-lesion revascularisation). At a median 362 days, Kaplan-Meier estimates were 14.4% with OCT versus 19.6% with IVUS (adjusted HR 0.90, 95% CI 0.59 to 1.36; p for noninferiority=0.0003). Findings were consistent when periprocedural MI was excluded and in per-protocol and competing-risk analyses. The trial does not establish equivalence or superiority. Source: ESC Congress 2026 press, 31 August 2026.
Yong Zeng (2026) conducted an RCT in True distal left main bifurcation lesions (n=664). Optical coherence tomography (OCT) guidance vs. Intravascular ultrasound (IVUS) guidance was evaluated on Target lesion failure (cardiac death, target-lesion-related myocardial infarction, or clinically driven target-lesion revascularisation) (HR 0.90, 95% CI 0.59-1.36, p=0.0003 for noninferiority). OCT-guided PCI was noninferior to IVUS-guided PCI for target lesion failure (14.4% vs 19.6%; HR 0.90, 95% CI 0.59-1.36; P=0.0003 for noninferiority).
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