{"id":"746e78273dd4","type":"article","url":"https://hartvaat.nl/2025/08/21/oct-versus-angiografie-bij-pci-van-verkalkte-laesies-driejaarsdata/","title":"OCT versus angiografie bij PCI van verkalkte laesies: driejaarsdata","title_en":"Optical coherence tomography- vs angiography-guided coronary stent implantation in calcified lesions: the ILUMIEN IV trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaf331","source_url":"https://doi.org/10.1093/eurheartj/ehaf331","authors":["Ziad A Ali","Doosup Shin","Rajesh Vijayvergiya","Atit A Gawalkar","Richard A Shlofmitz","Fernando Alfonso","Giuseppe Calligaris","Paolo Canova","Koshiro Sakai","Matthew J Price","David Leistner","Francesco Prati","Gary Mintz","Mitsuaki Matsumura","Robert J McGreevy","Robert W McNutt","Hong Nie","Jana Buccola","Ulf Landmesser","Akiko Maehara","Gregg W Stone"],"significance":6,"published":"2025-08-21","source_date":"2025-08-21","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/intravasculaire-echografie-ivus-oct/","https://hartvaat.nl/kennis/farmacologie/betablokkers-farmacologie/"],"congress":"","summary_en":"Three-year ILUMIEN IV data showed that the procedural advantage of OCT-guided PCI in calcified lesions now translates to improved clinical outcomes, establishing imaging guidance as particularly valuable for calcified coronary disease.","created":"2026-07-03T10:31:48Z","updated":"2026-07-03T13:30:48Z","licence":"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.","body_markdown":"Driejaarsdata bevestigden het voordeel van OCT-geleide PCI bij verkalkte laesies. Het procedurele voordeel vertaalt zich nu naar betere klinische uitkomsten op langere termijn.","abstract_original":"BACKGROUND AND AIMS: The large-scale, randomized ILUMIEN IV trial was examined to determine whether procedural guidance with optical coherence tomography (OCT) during percutaneous coronary intervention (PCI) of angiographically calcified lesions improves outcomes. METHODS: Patients with a single PCI target lesion were included in the present analysis. The presence of none, mild, moderate or severe lesion calcification was determined by an angiographic core laboratory. The primary imaging endpoint was the post-PCI minimal stent area (MSA) assessed by OCT. The primary clinical endpoint was 2-year target-vessel failure (TVF), a composite of cardiac death, target-vessel myocardial infarction (TV-MI), or ischaemia-driven target-vessel revascularization. RESULTS: In the overall population (n = 2114), there was a significant interaction between the effect of randomization to OCT guidance vs angiography guidance in lesions with moderate/severe calcification (n = 1082) vs no/mild calcification (n = 1032) on the 2-year rate of TVF (Pinteraction = .01). The post-PCI MSA in moderately and severely calcified lesions was larger with OCT guidance (n = 544) compared with angiography guidance (n = 538) (5.57 ± 1.86 mm2 vs 5.33 ± 1.78 mm2; P = .03). In the moderate/severe calcified lesion cohort, TVF within 2 years occurred in 35 patients with OCT guidance and in 51 patients with angiography guidance (6.8% vs 9.7%; adjusted hazard ratio [aHR] 0.62; 95% confidence interval [CI] 0.40-0.96), whereas there was no significant difference in TVF in the no/mild calcified lesion cohort (7.7% vs 5.2%; aHR 1.48; 95% CI 0.90-2.44) (Pinteraction = .01). In moderately/severely calcified lesions, OCT-guided PCI also reduced the 2-year rates of serious major adverse cardiac events (2.8% vs 4.7%; aHR 0.49; 95% CI 0.25-0.95; P = .03), TV-MI (1.9% vs 4.0%; aHR 0.36; 95% CI 0.17-0.79; P = .01), and stent thrombosis (0.2% vs 1.5%; aHR 0.11; 95% CI 0.01-0.89; P = .04) compared with angiography-guided PCI. CONCLUSIONS: In the ILUMIEN IV trial, OCT-guided PCI in patients with angiographically determined moderately or severely calcified lesions reduced the 2-year rate of TVF compared with angiography-guided PCI, an effect that was not seen in patients with lesions with no or mild angiographic calcium."}