OCT or Angiography Guidance for PCI in Complex Bifurcation Lesions

The OCTOBER trial, conducted across 38 European centers randomized 1201 patients with complex coronary-artery bifurcation lesions to receive PCI guided by either optical coherence tomography (OCT) or angiography. At 2 years, OCT-guided PCI significantly reduced major adverse cardiac events (MACE), defined as cardiac death, target-lesion myocardial infarction, or ischemia-driven target-lesion revascularization (10.1% vs. 14.1%; HR 0.70; P=0.035). Though procedural time and contrast usage were higher with OCT, imaging enabled superior lesion coverage, stent expansion, and malapposition correction. Safety outcomes (complications, renal injury) were similar between groups. Subgroup analysis showed particular benefit in one-stent bifurcation techniques. The trial established OCT-guided PCI as clinically superior for complex bifurcation lesions and proposed structured OCT imaging protocols for stent optimization. Multicenter validation is encouraged.

The OCTOBER trial, conducted across 38 European centers randomized 1201 patients with complex coronary-artery bifurcation lesions to receive PCI guided by either optical coherence tomography (OCT) or angiography. At 2 years, OCT-guided PCI significantly reduced major adverse cardiac events (MACE), defined as cardiac death, target-lesion myocardial infarction, or ischemia-driven target-lesion revascularization (10.1% vs. 14.1%; HR 0.70; P=0.035). Though procedural time and contrast usage were higher with OCT, imaging enabled superior lesion coverage, stent expansion, and malapposition correction. Safety outcomes (complications, renal injury) were similar between groups. Subgroup analysis showed particular benefit in one-stent bifurcation techniques. The trial established OCT-guided PCI as clinically superior for complex bifurcation lesions and proposed structured OCT imaging protocols for stent optimization. Multicenter validation is encouraged.