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Optical Coherence Tomography-Guided vs. Angiography-Guided Percutaneous Coronary Intervention for Complex Coronary

Muhammad Hamza Shuja1, Muhammad Ahmed2, Ramish Hannat3

  • 1Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan.

Diagnostics (Basel, Switzerland)
|August 14, 2025
PubMed

Insights

Optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) significantly reduces major adverse cardiovascular events, cardiac mortality, target lesion revascularization, and stroke in complex coronary lesions compared to angiography guidance.

Area of Science:

  • Cardiology
  • Medical Imaging

Background:

  • Coronary artery disease (CAD) treatment faces challenges, especially with complex lesions.
  • Percutaneous coronary intervention (PCI) outcomes can be impacted by restenosis.
  • Optical coherence tomography (OCT) offers higher resolution imaging than angiography for guiding PCI.

Purpose of the Study:

  • To conduct a meta-analysis comparing OCT-guided PCI with angiography-guided PCI.
  • To evaluate the effectiveness of OCT in improving clinical outcomes in complex coronary lesions.

Main Methods:

  • A systematic search of PubMed, Scopus, Cochrane Library, and ClinicalTrials.gov was performed up to May 2025.
  • Five randomized controlled trials (RCTs) involving 5737 patients were included.
  • Data were pooled using risk ratios (RRs) and mean difference (MD) with 95% confidence intervals (CIs) in a random-effects model.

Main Results:

  • OCT-guided PCI showed a significant reduction in major adverse cardiovascular event (MACE) (RR: 0.71, p=0.0001).
  • Significant reductions were observed in cardiac mortality (RR: 0.43, p=0.003), target lesion revascularization (TLR) (RR: 0.53, p=0.007), and stroke (RR: 0.17, p=0.02).
  • No significant differences were found for all-cause mortality or myocardial infarction.

Conclusions:

  • OCT-guided PCI is superior to angiography-guided PCI in reducing MACE, cardiac mortality, TLR, and stroke in patients with complex coronary lesions.
  • The findings support the integration of advanced imaging like OCT to enhance clinical outcomes in complex PCI procedures.

Keywords:
angiographymajor adverse cardiac eventsmeta-analysisoptical coherence tomographypercutaneous coronary intervention

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