Objective We sought to evaluate whether automated coregistration of optical coherence tomography (OCT) with angiography reduces geographic miss (GM) during coronary stenting. Background Previous intravascular ultrasound or OCT studies have showed that residual disease at the stent edge or stent edge dissection was associated with stent thrombosis or edge restenosis. This has been termed GM. Methods Two hundred de novo coronary lesions were randomized in a 1:1 ratio to OCT-guided percutaneous coronary intervention (PCI) with versus without automated coregistration of OCT with angiography. GM, the primary endpoint, was defined as angiographic >= type B dissection or diameter stenosis >50% or OCT minimum lumen area <4.0 mm(2) with significant residual disease or dissection (dissection flap >60 degrees) within 5 mm from the stent edge. Results The prevalence of GM was not different comparing OCT-guided PCI with versus without automated coregistration (27.6% vs 34.0%, P = 0.33). However, there was a trend toward a reduced prevalence of significant distal stent edge dissection in lesions with automated coregistration (11.1% vs 20.8%, P = 0.07). The discrepancy in the distance between planned versus actual implanted stent location with automated coregistration was significantly shorter than without coregistration (1.9 +/- 1.6 mm vs 2.6 +/- 2.7 mm, P = 0.03), especially the prevalence of >= 5 mm discrepancy that was less frequent with automated coregistration. Conclusions Automated coregistration of OCT with angiography did not reduce the primary endpoint of GM after stent implantation.