Intracoronary Imaging Implementation Gap in Contemporary PCI: The OCT2ACT Study

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Device Implementation

Background:

• Intracoronary imaging significantly improves outcomes in complex percutaneous coronary intervention (PCI).
• However, its consistent implementation in routine clinical practice remains a challenge.
• A gap exists between the potential benefits of intracoronary imaging and its actual use.

Purpose of the Study:

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

Main Methods:

• Prospective, multicenter study (OCT2ACT) involving 1,189 patients across 23 Italian centers.
• Patients categorized 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 the primary barriers (57.8%).
• Significant inter-center variation in imaging uptake (16.7%–100.0%); IVUS predominated when criteria met, OCT used more for clarification outside criteria.

Conclusions:

• Intracoronary imaging is underutilized in complex PCI even in capable centers.
• The implementation gap is primarily driven by operator attitudes and practice variations.
• Cost and technical limitations are not the sole or primary drivers of underuse.