Better Is the Evolution of Good: How IVUS and OCT Have Transformed PCI

Purpose of Review We seek to provide a focused appraisal of the most recent outcomes data for intravascular ultrasound (IVUS) and optical coherence tomography (OCT). Recent Findings There are multiple randomized control trials and meta-analyses investigating the effects of these two intravascular imaging (IVI) modalities on clinical decision-making and long-term clinical outcomes in percutaneous coronary intervention (PCI). While the effects of IVUS have been studied for decades, OCT is a newer form of IVI with less experience and data on its use in clinical practice. Summary IVUS-guided PCI has beneficial effects on mortality, stent thrombosis, target lesion/target vessel revascularization, and major adverse cardiac events when compared to angiography alone. While less data exists for OCT-guided PCI, early studies suggest it is at least non-inferior to IVUS for many of the same outcomes. However, future investigations should focus on how clinical outcomes are changed by these two IVI modalities when compared head-to-head.