IVUS-Guided PCI — New Trial Insights (ACC 2026)
IVUS-Guided PCI — New Trial Insights (ACC 2026)
• Two RCTs: OPTIMAL (left main) & IVUS-CHIP (complex PCI)
• Compared:
* IVUS-guided vs angiography-guided PCI
Key Results
• ❌ No superiority of IVUS on primary outcomes
• Trend toward:
* similar or slightly worse outcomes with IVUS (NS)
• ✔️ Exception:
* ↓ stent thrombosis with IVUS
Interpretation
• Results unexpected vs prior studies/meta-analyses
• Likely explanation:
👉 Highly experienced operators in both arms
Important Insight
• IVUS may:
* Improve operator skill over time
* Benefits become less visible in experts
Practical Impact
• ❗ Does NOT change current guidelines (still recommended)
• Suggests:
👉 IVUS may be selective, not mandatory in all cases
Limitations / Considerations
• ↑ procedure time (~+34%)
• ↑ cost
• Low incremental benefit in expert centers
🎯 Take-home
👉 IVUS remains valuable
👉 But added benefit depends on operator experience
👉 May be most useful in:
• Training
• Less experienced operators
• Selected complex cases
Source: ACC 2026 + NEJM (OPTIMAL & IVUS-CHIP)