Intracoronary Imaging Implementation Gap in Contemporary PCI: The OCT2ACT Study

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Imaging

Background:

• Intracoronary imaging enhances outcomes in complex percutaneous coronary intervention (PCI).
• Consistent implementation of intracoronary imaging in routine PCI practice remains a challenge.

Purpose of the Study:

• To quantify the implementation gap of intracoronary imaging in contemporary PCI.
• To identify operator-reported barriers to intracoronary imaging use when guideline-based criteria are met.
• To characterize modality selection beyond guideline-based criteria.

Main Methods:

• Prospective, multicenter OCT2ACT study enrolled 1,189 patients across 23 Italian centers.
• Patients classified into three cohorts based on predefined criteria and imaging use.
• Data collected on imaging modality selection and operator-reported barriers.

Main Results:

• 53% of patients meeting class IA criteria did not receive intracoronary imaging.
• Operator attitudes (angiography sufficient, unlikely to change strategy) were primary barriers (57.8%).
• Significant inter-center variation in imaging uptake (16.7%–100.0%); IVUS predominant in guideline-adherent use, OCT more common for clarification.

Conclusions:

• Intracoronary imaging is underutilized in complex PCI, even in capable centers.
• Operator attitudes and practice variations, not solely cost or technical issues, drive the implementation gap.
• Addressing attitudinal barriers is crucial for increasing intracoronary imaging adoption in PCI.