Key result
OCT-guided PCI showed consistent 1-year MACE rates vs angiography-guided PCI in both LAD (4.5% vs 5.5%; p=0.486) and non-LAD lesions (4.6% vs 7.7%; p=0.154; p_interaction=0.351).
Why the study?
The OCCUPI trial demonstrated the clinical benefit of OCT-guided PCI in complex coronary lesions, but whether the effect of OCT guidance differs between LAD and non-LAD coronary vessels remained unclear.
Does OCT-guided PCI reduce 1-year major adverse cardiovascular events compared to conventional angiography-guided PCI consistently across LAD and non-LAD coronary lesions in patients with complex coronary lesions without left main disease?
RCT (n=1,375)
Randomized
Does OCT-guided PCI reduce 1-year major adverse cardiovascular events compared to conventional angiography-guided PCI consistently across LAD and non-LAD coronary lesions in patients with complex coronary lesions without left main disease?
In patients with complex non-left main coronary lesions, the clinical benefit of OCT-guided PCI over angiography-guided PCI—specifically fewer repeat revascularizations and a trend toward lower MACE—is consistent regardless of whether the target lesion is in the LAD or a non-LAD vessel.
Answers are grounded in this paper and cite their sources.
Supports OCT guidance irrespective of LAD involvement; extends OCCUPI trial by confirming consistent effects without location interaction.
Purpose The OCCUPI trial demonstrated the clinical benefit of optical coherence tomography (OCT)–guided percutaneous coronary intervention (PCI) in patients with complex coronary lesions. However, whether the effect of OCT guidance differs according to coronary lesion vessel remains unclear. This prespecified substudy evaluated the consistency of clinical outcomes with OCT-guided PCI in left anterior descending (LAD) versus non-LAD coronary vessels. Methods Among 1,375 patients without left main disease enrolled in the OCCUPI trial, 888 had LAD lesions and 487 had non-LAD lesions. Patients were randomized to undergo PCI guided by either OCT or conventional angiography. The primary endpoint was 1-year major adverse cardiovascular events (MACE), defined as a composite of cardiac death, myocardial infarction, stent thrombosis, or ischemia-driven target-vessel revascularization (TVR). Event rates were assessed using Kaplan–Meier analysis, and group differences were compared using the log-rank test. Results In the LAD group, 1-year MACE occurred in 4.5% of patients treated with OCT-guided PCI and 5.5% of those treated with angiography-guided PCI, with no statistically significant difference on Kaplan–Meier analysis (overall log-rank p = 0.486). In the non-LAD group, corresponding MACE rates were 4.6% and 7.7%, respectively, also without a significant difference (overall log-rank p = 0.154). There was no significant interaction between lesion location and PCI guidance strategy (p for interaction = 0.351). Ischemia-driven TVR occurred less frequently with OCT-guided PCI in both LAD and non-LAD lesions, without evidence of heterogeneity according to lesion location (p for interaction = 0.872). Conclusions In patients with complex coronary lesions, OCT-guided PCI was associated with fewer repeat revascularizations and a consistent trend toward improved clinical outcomes compared with angiography-guided PCI, irrespective of coronary lesion location.
No takes yet. Share an insight, caveat, or question.
Heo et al. (2026) conducted an RCT in Complex coronary lesions (LAD versus non-LAD vessels) (n=1,375). Optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) vs. Conventional angiography-guided PCI was evaluated on 1-year major adverse cardiovascular events (MACE), defined as a composite of cardiac death, myocardial infarction, stent thrombosis, or ischemia-driven target-vessel revascularization (TVR) (p=0.486 (LAD); 0.154 (non-LAD); 0.351 for interaction). OCT-guided PCI showed consistent 1-year MACE rates vs angiography-guided PCI in both LAD (4.5% vs 5.5%; p=0.486) and non-LAD lesions (4.6% vs 7.7%; p=0.154; p_interaction=0.351).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: