# OCT-gebaseerde post-PCI fysiologiebeoordeling voorspelt klinische uitkomsten

*geplaatst 2025-07-15 · Algemeen · Journal of the American College of Cardiology · doi 10.1016/j.jacc.2025.05.019 · https://hartvaat.nl/2025/07/15/oct-gebaseerde-post-pci-fysiologiebeoordeling-voorspelt-klinische-uitkomsten/*

Studie toonde dat OCT-gebaseerde fysiologische beoordeling na stentimplantatie klinische uitkomsten voorspelt. Suboptimale stentexpansie en restischemie kunnen direct na de procedure worden gecorrigeerd.

## English: Impact of Optical Coherence Tomography-Based Post-PCI Physiology Assessment to Predict Clinical Outcomes: An ILUMIEN-IV Substudy.

This study showed that OCT-based virtual flow reserve assessment after PCI predicts clinical outcomes, combining anatomical and physiological evaluation in a single imaging modality for post-procedure optimization.

## Abstract (original, from the publication)

BACKGROUND: A novel optical coherence tomography (OCT)-based physiology assessment technique, virtual flow reserve (VFR), has been demonstrated to perform as a reliable surrogate for invasive physiology. OBJECTIVES: The authors sought to examine the performance of post-percutaneous coronary intervention (PCI) VFR as a predictor of 2-year clinical outcomes independent from the OCT-based minimal stent area (MSA). METHODS: The ILUMIEN IV (Optical Coherence Tomography [OCT] Guided Coronary Stent Implantation Compared With Angiography: A Multicenter Randomized Trial in PCI) trial prospectively recruited 2,487 patients with diabetes or high-risk coronary lesions randomizing to OCT- vs angiography-guided drug-eluting stent implantation. All patients with single-lesion treatment who had a final OCT imaging available underwent retrospective post-PCI VFR analysis offline. Of 2,128 eligible patients, VFR analysis was successfully performed in 2,057 (96.6%). Independent OCT predictors for the primary endpoint of 2-year target vessel failure (TVF), a composite of cardiac death, target-vessel myocardial infarction, and ischemia-driven target vessel revascularization, were evaluated by multivariable analysis. RESULTS: The median post-PCI VFR was 0.90 (Q1-Q3: 0.86-0.92), with a significant difference in VFR observed between the angiography- and OCT-guided groups (0.89 [Q1-Q3: 0.86-0.92] vs 0.90 [Q1-Q3: 0.87-0.92]; P < 0.001). By multivariable analysis, both MSA (per 1 mm2) and VFR (per 0.1 mm Hg/mm Hg) were independent predictors of 2-year TVF. Overall, MSA, proximal edge dissection and VFR independently predicted both TVF and target lesion failure. CONCLUSIONS: Post-PCI OCT-based VFR assessment is predictive of 2-year clinical outcomes independent of MSA. Online VFR analysis can provide operators with an immediate assessment of post-PCI physiology in addition to OCT anatomy, providing incremental value in assessing procedural success and informing on clinical prognosis (ILUMIEN IV [Optical Coherence Tomography (OCT) Guided Coronary Stent Implantation Compared With Angiography: A Multicenter Randomized Trial in PCI]; NCT03507777).

Auteurs: Thomas W Johnson, Brian A Bergmark, Kevin Croce, Dario Pellegrini, Akiko Maehara, Tommaso Gori, Natalia Pinilla-Echeverri, Jason Wollmuth, Nieves Gonzalo, Hsien-Li Kao, Giulio Guagliumi, Kanitha Phalakornkule, Divine Ediebah, JoAnna McNutt, Wei-Che Chiu, Jorn Op den Buijs, Jana Buccola, Ulf Landmesser, Ziad Ali, Gregg W Stone, Allen Jeremias

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Bron: Journal of the American College of Cardiology, https://doi.org/10.1016/j.jacc.2025.05.019. Bijgewerkt 2026-07-03T13:30:44Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.