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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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IVUS, OCT, or Angiography as Guidance for PCI in Complex Coronary Artery Lesions: Network Meta-Analysis of Randomized

Pedro E P Carvalho1, Vanio L J Antunes2, Vinicius Bittar de Pontes3

  • 1Center for Coronary Artery Disease, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.

JACC. Cardiovascular Interventions
|January 14, 2026
PubMed

Insights

Intravascular imaging guidance, including optical coherence tomography (OCT) and intravascular ultrasound (IVUS), significantly reduces major adverse cardiovascular events (MACE) in complex coronary lesions compared to angiography alone. Both OCT- and IVUS-guided percutaneous coronary intervention (PCI) prove superior for complex lesions.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Imaging

Background:

  • Intravascular imaging-guided percutaneous coronary intervention (PCI) is known to reduce cardiovascular events.
  • Limited data exists comparing intravascular ultrasound (IVUS) and optical coherence tomography (OCT) against angiography in complex coronary lesions.

Purpose of the Study:

  • To compare the efficacy of IVUS- and OCT-guided PCI versus angiography-guided PCI in reducing major adverse cardiovascular events (MACE).
  • To analyze outcomes in specific complex coronary lesion subgroups.

Main Methods:

  • A lesion-level network meta-analysis of randomized controlled trials was conducted.
  • Data from MEDLINE, Embase, and Cochrane databases were systematically searched for trials comparing OCT, IVUS, and angiography for PCI guidance with drug-eluting stents (DES).
  • A frequentist random-effects model was used to calculate risk ratios (RRs) for MACE, defined as cardiac death, myocardial infarction, or target vessel revascularization.

Main Results:

  • Seventeen trials involving 13,751 patients with complex coronary lesions were analyzed.
  • Both OCT (RR: 0.63) and IVUS (RR: 0.67) significantly reduced MACE compared to angiography-guided PCI.
  • These benefits were consistent across subgroups including chronic total occlusions, left main disease, bifurcation lesions, multivessel disease, and calcified lesions. No significant difference in MACE was found between OCT and IVUS.

Conclusions:

  • OCT-guided and IVUS-guided PCI are more effective than angiography-guided PCI in reducing MACE for patients with complex coronary lesions undergoing PCI with DES.
  • Intravascular imaging guidance is recommended for PCI in complex coronary lesions.
Abstract

Keywords:
intravascular imagingintravascular ultrasoundoptical coherence tomography

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