Clinical Research And EvidenceEvidence

OPTIMAL and IVUS-CHIP trials show no superiority of IVUS-guided PCI over angiography guidance

March 30, 2026NEJM, Davide Capodanno, American College of Cardiology

NEJM and Davide Capodanno highlight that IVUS guidance did not reduce ischemic events/target-vessel failure versus angiography guidance in unprotected left main and complex high-risk PCI, prompting reassessment of when IVUS adds clinical value.

“intravascular ultrasonography–guided PCI did not result in a lower risk of ischemic events or death than angiography-guided PCI.”
“the risk of target-vessel failure (a composite outcome) was not lower with intravascular ultrasound guidance than with angiography guidance.”
“OPTIMAL suggests that using IVUS in unprotected left main PCI may cost you 22 minutes with no clinical benefit.”
“IVUS-CHIP reports no advantage of IVUS over angiography in complex high-risk PCI.”
“Results of IVUS-CHIP and OPTIMAL: When compared with angiography-guided #PCI, IVUS-guided PCI was found to be not superior”
NEJM
Davide Capodanno
American College of Cardiology
PCIIVUSACC26

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