Efficacy and safety of optical coherence tomography-guided versus angiography-guided percutaneous coronary...

The optimal imaging guidance for percutaneous coronary intervention (PCI) in complex coronary lesions remains a matter of debate. This meta-analysis compares the efficacy and safety of optical coherence tomography (OCT)-guided PCI versus angiography-guided PCI.

Following PRISMA guidelines, we systematically searched PubMed, Embase, Cochrane, and ClinicalTrials.gov from inception to December 2024. Randomized controlled trials (RCTs) comparing OCT-guided PCI to angiography-guided PCI were included. Data analysis was performed using RevMan 5.4, with risk ratios (RR) and 95% confidence intervals (CI) calculated for dichotomous outcomes using a random-effects model. Risk of bias was assessed using the Cochrane RoB 2.0 tool.

Eleven RCTs involving 6432 participants were included. OCT-guided PCI showed no statistically significant reduction in all-cause mortality compared to angiography-guided PCI (RR 0.72, 95% CI 0.51-1.01, P = 0.06, I ² = 0%). However, OCT-guided PCI was associated with a significant reduction in cardiac death (RR 0.52, 95% CI 0.30-0.90, P = 0.02, I ² = 0%), major adverse cardiovascular events (MACE) (RR 0.70, 95% CI 0.55-0.89, P = 0.003, I ² = 0%), stent thrombosis (RR 0.53, 95% CI 0.33-0.87, P = 0.01, I ² = 0%), and major edge dissection (RR 0.47, 95% CI 0.34-0.65, P < 0.00001, I ² = 0%). Upon stratification of studies on the basis of follow-up duration, similar results were noted.

OCT-guided PCI demonstrated significant benefits in reducing cardiac death, MACE, and procedural complications compared to angiography-guided PCI. These findings support the integration of OCT in complex PCI, although further studies are warranted to assess its impact on long-term mortality.