Optical coherence tomography (OCT) - versus angiography-guided strategy for percutaneous coronary intervention: a meta-analysis of randomized trials

BMC Cardiovasc Disord. 2024 May 20;24(1):262. doi: 10.1186/s12872-024-03930-y.

Abstract

Background: Optical coherence tomography (OCT) guidance in percutaneous coronary intervention (PCI) has been shown to improve procedural outcomes. However, evidence supporting its superiority over angiography-guided PCI in terms of clinical outcomes is still emerging and limited. This study aimed to compare the efficacy and safety of OCT-guided PCI versus angiography-guided PCI in patients with coronary artery disease (CAD).

Methods: A systematic search of electronic databases was conducted to identify randomized control trials (RCTs) comparing the clinical outcomes of OCT-guided and angiography-guided PCI in patients with CAD. Clinical endpoints including all-cause mortality, myocardial infarction (MI), target lesion revascularization (TLR), stent thrombosis and major adverse cardiac events (MACE) were assessed.

Results: Eleven RCTs, comprising 2,699 patients in the OCT-guided group and 2,968 patients in the angiography-guided group met inclusion criteria. OCT-guided PCI was associated with significantly lower rates of cardiovascular death(RR 0.56; 95%CI: 0.32-0.98; p = 0.04; I2 = 0%), stent thrombosis(RR 0.56; 95%CI: 0.33-0.95; p = 0.03; I2 = 0%), and MACE (RR 0.79; 95%CI: 0.66-0.95; p = 0.01; I2 = 5%). The incidence of all-cause death (RR 0.71; 95%CI: 0.49-1.02; p = 0.06; I2 = 0%), myocardial infarction (RR 0.86; 95%CI: 0.67-1.10; p = 0.22; I2 = 0%) and TLR (RR 0.98; 95%CI: 0.73-1.33; p = 0.91; I2 = 0%) was non-significantly lower in the OCT-guided group.

Conclusions: Among patients undergoing PCI, OCT-guided PCI was associated with lower incidences of cardiovascular death, stent thrombosis and MACE compared to angiography-guided PCI.

Trial registration: PROSPERO registration number: CRD42023484342.

Keywords: Coronary angiography; Coronary artery disease; Optical coherence tomography; Percutaneous coronary intervention.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Aged
  • Coronary Angiography*
  • Coronary Artery Disease* / diagnostic imaging
  • Coronary Artery Disease* / mortality
  • Coronary Artery Disease* / therapy
  • Coronary Thrombosis / diagnostic imaging
  • Coronary Thrombosis / etiology
  • Coronary Vessels / diagnostic imaging
  • Female
  • Humans
  • Male
  • Middle Aged
  • Percutaneous Coronary Intervention* / adverse effects
  • Percutaneous Coronary Intervention* / instrumentation
  • Percutaneous Coronary Intervention* / mortality
  • Predictive Value of Tests*
  • Randomized Controlled Trials as Topic*
  • Risk Factors
  • Tomography, Optical Coherence*
  • Treatment Outcome