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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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Contemporary evidence for intravascular imaging-guided percutaneous coronary intervention: a systematic review and

Nora N Almouaalamy1,2, Hasen H Aljadani1,2, Ruqayyah A Ahmed3

  • 1King Abdullah International Medical Research Centre.

Journal of Cardiovascular Medicine (Hagerstown, Md.)
|January 13, 2026
PubMed

Insights

Intravascular imaging guidance for percutaneous coronary intervention (PCI) significantly reduces risks of death, myocardial infarction, and stent thrombosis compared to traditional methods. This supports wider use of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) in PCI procedures.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Imaging

Background:

  • Coronary artery disease (CAD) is a major global health concern.
  • Percutaneous coronary intervention (PCI) is a common treatment for CAD.
  • Comparing guidance strategies for PCI is crucial for optimizing patient outcomes.

Purpose of the Study:

  • To compare clinical outcomes of intravascular imaging-guided PCI versus angiography or fractional flow reserve (FFR)-guided PCI.
  • To evaluate the efficacy of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) in guiding PCI.
  • To assess the impact of different PCI guidance methods on major adverse cardiac events.

Main Methods:

  • Systematic search of six databases for randomized controlled trials (RCTs) up to October 2024.
  • Included RCTs compared IVUS/OCT-guided PCI with angiography/FFR-guided PCI.
  • Pooled risk ratios (RRs) using a random-effects model for primary outcomes including target-vessel failure (TVF), myocardial infarction (MI), mortality, and stent thrombosis.

Main Results:

  • Analysis of 18 RCTs with 21,812 patients.
  • Imaging-guided PCI showed significantly lower risks of TVF (RR: 0.66), cardiac death (RR: 0.56), all-cause mortality (RR: 0.77), MI (RR: 0.84), and definite stent thrombosis (RR: 0.41).
  • No significant differences were found for repeat revascularization or contrast-induced nephropathy.

Conclusions:

  • Intravascular imaging-guided PCI significantly improves key clinical outcomes compared to angiography or FFR guidance.
  • Findings support the broader implementation of IVUS and OCT in contemporary PCI.
  • These imaging modalities are particularly beneficial for patients with complex coronary disease.
Abstract

Keywords:
angiographycoronary artery diseaseintravascular ultrasoundmeta-analysisoptical coherence tomographypercutaneous coronary intervention

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