Intracoronary Imaging Implementation Gap in Contemporary Percutaneous Coronary Intervention (PCI): The OCT2ACT Study
Authors' conclusion
Even in imaging-capable centers, intracoronary imaging remains underused in anatomically complex PCI. This implementation gap appears driven predominantly by operator attitudes and intersite practice variation rather than by cost or technical barriers alone. (Barriers Limiting OCT Penetration in Clinical Practice [OCT2ACT]; NCT07193693).
Study context
- Population
- Consecutive patients undergoing PCI across Italian imaging-capable centers between September 15 and December 15, 2025consecutive patients enrolled
- Participants
- 1,189 patients
- Exposure
- Cohort 1 vs cohort 2 vs cohort 3
- Outcome
- No intracoronary imaging among patients meeting predefined class IA criteria
Methodological detailsconsecutive patients, 23 Italian imaging-capable centers
- Consecutive patients
- 23 Italian imaging-capable centers
Main finding
As reported in the abstract
Patients meeting predefined class IA criteria
908
Of whom did not undergo intracoronary imaging
481
53.0%
Observational data: associations, not effects.
Further findings
| Outcome | Cohort 2 | Cohort 3 |
|---|---|---|
| Imaging modality | ||
| IVUS | 72% | — not stated in the abstract |
| Optical coherence tomography | — not stated in the abstract | 54% |
— not stated in the abstract
- Imaging modality: in cohort 3 mainly for diagnostic clarification in ambiguous acute coronary syndromes or stent failure
Barriers to imaging use
- Angiography considered sufficient or imaging judged unlikely to change PCI strategy (operator-reported attitudinal factors)
- 278 patients (57.8%)
Imaging uptake across centers
- Range of imaging uptake across centers
- 16.7% to 100.0%
Original publication
Intracoronary Imaging Implementation Gap in Contemporary PCI: The OCT2ACT Study. JACC Adv. Published 17 July 2026. doi:10.
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