Optical coherence tomography-guided versus angiography-guided percutaneous coronary intervention: A meta-analysis of randomized controlled trials

Optical Coherence Tomography (OCT), a high-resolution imaging modality, guides stent implantation during percutaneous coronary intervention (PCI). However, OCT-guided PCI safety and efficacy data is limited. MEDLINE, Embase, and Cochrane Central were searched for randomized controlled trials (RCTs) comparing OCT-guided PCI to Angiography-guided PCI from inception to August 2023. A random-effects model was used to pool risk ratios (RRs), mean differences (MDs), and 95% confidence intervals (CIs) for clinical endpoints. Our analysis included 5,139 patients from 11 studies. OCT-guided PCI resulted in a higher minimum stent area (MD = 0.35 95 % CI, 0.21–0.49; p < 0.00001), significantly reduced risk of cardiovascular mortality (RR = 0.56 95 % CI, = 0.32–0.99; p = 0.04), stent thrombosis (RR = 0.56 95 % CI, 0.32–0.96; p = 0.04), stent malapposition RR = 0.79 95 % CI, 0.71–0.88; p = < 0.0001) and major edge dissection (RR = 0.47 95 % CI, 0.34–0.65; p = <0.00001). However, no statistically significant difference was observed for all-cause mortality (RR = 0.71; p = 0.06), major adverse cardiovascular events (MACE) RR = 0.80; p = 0.10, myocardial infarction (MI) RR = 0.84; p = 0.16, target lesion revascularization (TLR) RR = 0.94; p = 0.68, and target vessel revascularization (TVR) RR = 0.91; p = 0.52. OCT-guided PCI led to an increased MSA and decreased cardiovascular mortality, stent thrombosis, stent malapposition, and major edge dissection. The incidence of all-cause mortality, MACE, MI, TLR, and TVR remained comparable across the two groups.