Optical Coherence Tomography Versus Angiography Alone to Guide PCI for Complex Lesions: A Meta-Analysis of Randomized Controlled Trials.

Background: Optical coherence tomography (OCT) provides high-resolution intracoronary imaging. However, whether the addition of OCT to angiography to guide percutaneous coronary intervention (PCI) of complex lesions affects clinical outcomes is debated.

Methods: A systematic search for randomized controlled trials was conducted using PubMed, Scopus, and Cochrane databases through September 2024. End points included major adverse cardiovascular events, cardiac death, myocardial infarction, periprocedural myocardial infarction, all-cause mortality, stent thrombosis (definite or probable), and target-vessel revascularization. The random-effects model was used to generate risk ratios (RRs) and 95% CIs.

Results: A literature search identified 4 randomized controlled trials including 5603 patients with a median follow-up of 2 years. Compared with PCI guided by angiography alone, OCT-guided PCI was associated with lower major adverse cardiovascular events (RR, 0.68 [95% CI, 0.55-0.84]; <0.001), cardiac death (RR, 0.43 [95% CI, 0.24-0.76]; =0.003), myocardial infarction (RR, 0.75 [95% CI, 0.59-0.96]; =0.02), all-cause mortality (RR, 0.58 [95% CI, 0.38-0.87]; =0.009, and stent thrombosis (RR, 0.49 [95% CI, 0.26-0.90]; =0.02). There was a trend toward lower target-vessel revascularization (RR, 0.67 [95% CI, 0.44-1.03]; =0.07) and lower periprocedural myocardial infarction (RR, 0.79 [95% CI, 0.59-1.06]; =0.11) with OCT guidance compared with angiography alone.

Conclusions: The addition of OCT guidance to PCI of complex lesions resulted in better clinical outcomes than angiography guidance alone. Updated guidelines should strengthen recommendations supporting the use of OCT guidance for complex PCI.

Registration: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42024603847.