Optical Coherence Tomography vs. Angiography Alone to Guide PCI for Complex Lesions: A Meta-Analysis of Randomized Controlled Trials

• DOI: 10.1161/circinterventions.125.015141
• Publication Date: 2025-03-30T20:00:31Z
• Authors: Chidubem Ezenna; Mrinal Murali Kri...; Meghna Joseph; Sammudeen Ibrahim; Vinicius Pereira; Ancy Jenil-Franco; Michael G. Nanna; Sripal Bangalore; Andrew M. Goldsweig

Background: Optical coherence tomography (OCT) provides high-resolution intracoronary imaging. However, whether the addition of OCT to angiography to guide percutaneous coronary intervention (PCI) of complex lesions affects clinical outcomes is debated.

Methods: A systematic search for randomized controlled trials (RCTs) was conducted using PubMed, Scopus, and Cochrane databases through September 2024. Endpoints included major adverse cardiovascular events (MACE), cardiac death, myocardial infarction (MI), periprocedural MI, all-cause mortality, stent thrombosis (definite or probable), and target vessel revascularization (TVR). The random-effects model was used to generate risk ratios (RRs) and 95% confidence intervals (CIs).

Results: A literature search identified 4 RCTs including 5,603 patients with a median follow-up of 2 years. Compared with PCI guided by angiography alone, OCT-guided PCI was associated with lower MACE (RR 0.68; 95%CI 0.55-0.84; p<0.001), cardiac death (RR 0.43; 95%CI 0.24-0.76; p=0.003), MI (RR 0.75; 95%CI 0.59-0.96; p=0.02), all-cause mortality (RR 0.58; 95% CI 0.38–0.87; p=0.009, and stent thrombosis (RR 0.49; 95% CI 0.26–0.90; p=0.02). There was a trend toward lower TVR (RR 0.67; 95% CI 0.44–1.03; p=0.07) and lower periprocedural MI (RR 0.79; 95% CI 0.59–1.06; p=0.11) with OCT guidance compared to angiography alone.

Conclusions: The addition of OCT guidance to PCI of complex lesions resulted in better clinical outcomes than angiography guidance alone. Updated guidelines should strengthen recommendations supporting the use of OCT guidance for complex PCI.