The following are key points to remember from this state-of-the-art review on improving percutaneous coronary intervention (PCI) outcomes using postprocedural physiology and intravascular imaging:

1. Although clinical outcomes after PCI are improving, the long-term risk for target vessel failure remains concerning.
2. The application of intravascular imaging and physiological indexes significantly improves outcomes; however, their routine use in practice remains limited.
3. Of note, merely using these modalities is not enough, and to truly improve patient outcomes, optimal intravascular dimensions with minimal vascular injury should be targeted.
4. Recent studies have demonstrated that stent optimization through intravascular imaging and coronary physiology after stenting can affect clinical outcomes.
5. The body of evidence is convincing on the benefit of intravascular ultrasound (IVUS), optical coherence tomography (OCT), and fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR) for PCI optimization.
6. Newer indexes such as three-dimensional quantitative coronary angiography–based FFR and nonhyperemic pressure ratios have the potential to further advance the field.
7. Each technology has its own benefits and drawbacks and requires dedicated training to be able to appreciate the wide spectrum of stent- and vessel-related issues that can be encountered post-PCI.
8. This goal can be achieved only by accurate procedural planning, adequate assessment of pre- and post-PCI imaging and physiology, and treating those remaining issues that might cause future events.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Vascular Medicine, Interventions and Imaging, Interventions and Vascular Medicine, Angiography, Echocardiography/Ultrasound, Nuclear Imaging

Keywords: Coronary Angiography, Diagnostic Imaging, Fractional Flow Reserve, Myocardial, Myocardial Ischemia, Percutaneous Coronary Intervention, Physiology, Secondary Prevention, Stents, Tomography, Optical Coherence, Ultrasonography, Ultrasonography, Interventional, Vascular System Injuries

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