VIDEO: ILUMIEN IV: OCT adds value over angiography alone, fails to improve outcomes

The ILUMIEN IV trial, published Oct. 19 in the New England Journal of Medicine (NEJM) and presented at ESC Congress 2023, compared optical coherence tomography (OCT)–guided percutaneous coronary intervention (PCI) with angiography-guided PCI.[1] While the trial did not show improved outcomes using OCT, OCT-guided PCI resulted in a small improvement in acute minimal stent area and other benefits. 

The trial was conducted during the COVID-19 pandemic, and those involved said this played a big role in their final outcomes. To find out more, Cardiovascular Business spoke with the principal investigator of the trial, Ziad Ali, MD, director of the DeMatteis Cardiovascular Institute, director of investigational interventional cardiology and director of the cardio-renal program at St. Francis Hospital and Heart Center in Roslyn, New York.

Ali explained that, among patients undergoing PCI, OCT guidance resulted in a larger minimum stent area than angiography guidance. However, there was no apparent between-group difference in the percentage of patients with target-vessel failure at 2 years, which was the trial's primary end-point.

"Then when we looked at two years, the rates of target vessel failure were not actually difference between OCT and angiography. But when we looked specifically at the components of target vessel failure (TVF), we found 20 to 40% reductions in cardiovascular death and target vessel myocardial infarction, consistent really with intravascular imaging studies that have been done previously," Ali said.