Patients with diabetes remained at increased risk for adverse events after PCI compared with nondiabetic patients despite the use of OCT procedural guidance, and OCT guidance did not reduce TVF or serious MACE compared with angiography guidance in either diabetic or nondiabetic patients.
Diabetic patients had significantly higher 2-year rates of target vessel failure compared with nondiabetic patients after PCI.
Diabetic patients had significantly higher 2-year rates of serious major adverse cardiovascular events (MACE) compared with nondiabetic patients.
OCT guidance compared with angiography guidance did not reduce TVF or serious MACE in the overall randomized population.
The benefit (or lack thereof) of OCT guidance over angiography guidance did not differ between diabetic and nondiabetic patients.
Patients with diabetes and complex lesions were at particularly high risk for adverse outcomes after PCI.
The study population consisted of patients from the ILUMIEN IV trial randomized to OCT-guided versus angiography-guided PCI, stratified by diabetes status.
This research examined whether using a high-resolution imaging technique called optical coherence tomography (OCT) during heart artery stenting procedures (PCI) could improve outcomes for patients with diabetes, who are known to have worse outcomes after these procedures compared to patients without diabetes. The study analyzed data from over 2,400 patients in the large ILUMIEN IV clinical trial, about 1,000 of whom had diabetes, following them for two years after their procedure. The study found that patients with diabetes had roughly 50% higher risk of target vessel failure (a composite of heart-related death, heart attack, or repeat procedures on the treated artery) and nearly 80% higher risk of serious cardiovascular events compared to patients without diabetes, even after accounting for other differences between the groups. Patients with both diabetes and more complex artery blockages faced the highest risks of all. However, using OCT imaging to guide the stenting procedure — compared to using standard X-ray imaging alone — did not reduce these risks in either diabetic or nondiabetic patients, and there was no meaningful difference in how much OCT helped (or didn't help) between the two groups. This research suggests that while diabetes remains a strong risk factor for worse outcomes after heart artery stenting procedures, upgrading the imaging technology used during the procedure alone may not be sufficient to close this gap. The findings highlight that patients with diabetes, especially those with complex coronary artery disease, represent a high-risk group that may need additional or different strategies beyond improved procedural guidance to improve their long-term outcomes after PCI.
Gaede L, Achenbach S, Marwan M, Shlofmitz R, Fabbiocchi F, Alfonso F, et al.. (2026). Impact of Diabetes on Outcomes of Contemporary PCI Guided by OCT vs Angiography: The ILUMIEN IV Trial.. JACC. Cardiovascular interventions. https://doi.org/10.1016/j.jcin.2026.06.028