OCT-Guided Stent Optimization in Complex PCI: OCCUPI Shows Optimization Predicts Markedly Better 1‑Year Outcomes

Highlights

– In the OCCUPI trial, 71% (549/773) of OCT‑guided PCI procedures met predefined OCT optimization criteria; optimized procedures had a 1‑year primary event rate of 2.9% versus 9.4% when criteria were not met (HR 0.30, 95% CI 0.16–0.58, P < .001).
– Long lesions and small‑vessel disease were independent predictors of OCT sub‑optimization.
– Key OCT components—adequate stent expansion, minimal malapposition, and absence of major edge dissection—were each strongly associated with improved outcomes.

Background: Why intravascular imaging and optimization matter