Real‐time optical coherence tomography coregistration with angiography in percutaneous coronary intervention–impact on physician decision‐making: The OPTICO‐integration study

Aims Intracoronary optical coherence tomography (OCT) imaging allows for high‐resolution characterization of coronary lesions. Difficulties in matching cross‐sectional OCT‐images with angiographic lesion localization may limit optimal clinical utilization. We sought to prospectively assess the impact of a novel system of real‐time OCT coregistration with angiography (ACR) on physician decision‐making during percutaneous coronary interventions (PCI). Methods and Results Strategy for PCI (stent ‐ length, ‐ diameter, ‐ strategy, landing zone) and PCI‐optimization (stent‐malappostion, ‐underexpansion, edge‐dissections, geographical mismatch) was prospectively assessed in 50 patients with 58 coronary lesions after (I) angiography, (II) OCT imaging, and (III) ACR. Preprocedural OCT imaging altered stent‐length (58.9%), diameter (33.9%), and PCI‐strategy (12.5%) in 40 (71.4%) lesions. The use of ACR resulted in additional changes in PCI strategy in 40.7% of mostly complex lesions in comparison to OCT imaging alone and involved mainly device landing zone (24.1%) and stent length (22.2%). Postprocedural OCT imaging revealed the need for PCI optimization in 52.2% of the lesions, whereas post‐procedural ACR had no further impact. Conclusions Real‐time OCT ACR had significant impact on PCI strategy, favoring mainly complete lesion coverage especially in complex lesions.