Intravascular ultrasound (IVUS) guidance during percutaneous coronary intervention (PCI) provides a superior assessment of coronary artery dimensions, plaque morphology, and optimal stent expansion compared with coronary angiography. Optical coherence tomography (OCT) was developed as an additional intravascular imaging tool for PCI guidance. Several studies have demonstrated improved clinical outcomes with OCT-guided PCI compared with angiography-guided PCI. , The axial resolution provided by OCT is 10 times higher than that by IVUS; hence, OCT can detect fine details such as edge dissections and tissue coverage of stent struts that may be missed by IVUS imaging. However, OCT has less tissue penetration (OCT 1 to 2 mm vs IVUS 5 to 6 mm). IVUS is preferred in left main disease given its penetration power, whereas the depth of calcium is better evaluated by OCT. In their 2018 coronary revascularization guidelines, the European Society of Cardiology recommended OCT or IVUS in selected patients for stent optimization (IIA, LOE B) and in the detection of stent-related mechanical problems leading to stenosis (IIA, LOE C). However, because of the better penetration, IVUS was recommended for unprotected left main lesions (IIA, LOE B). Given the lack of robust comparative data, the use of IVUS or OCT in PCI guidance is mainly based on operator experience. Recently, multiple studies have compared clinical outcomes between OCT-guided versus IVUS-guided PCI, thus we performed this meta-analysis
We conducted a meta-analysis including the studies evaluating the clinical outcomes of OCT-guided versus IVUS-guided in low-risk PCI. Studies that included patients with left main disease, in-stent stenosis, and patients with a history of coronary artery bypass grafting were all excluded. Our primary outcome is major cardiac adverse events. Secondary outcomes consisted of all-cause death, myocardial infarction, stent thrombosis, and target lesion revascularization. Statistical analysis was conducted using Review Manager (RevMan), version 5.3 (The Cochrane Collaboration, Copenhagen, Denmark). The Mantel-Haenszel random-effects models were used to estimate odds ratios and the corresponding 95% confidence intervals. Categorical variables were compared using the chi-square test, while continuous variables were compared using a 2-sample Student’s t test. Two-sided p <0.05 were considered statistically significant. I 2 statistics were used to assess statistical heterogeneity.
A total of 4 randomized controlled trials and 1 propensity-matched observational study were included, with a total of 1,544 patients and a median weighted follow-up period of 1.26 years. Of the total population, 51% were in the OCT arm and 49% in the IVUS arm. There was no significant difference in age (OCT 65.7 ± 8 vs IVUS 65.2 ± 8 years of age), gender (OCT 27.5% vs IVUS 29.3% female), hypertension (OCT 70.3% vs IVUS 70.1%), diabetes mellitus (OCT 35.1% vs IVUS 36.1%), or acute coronary syndrome (OCT 30% vs IVUS 32%). Our pooled analysis showed a similar risk of major cardiac adverse events (OCT 5.0% vs IVUS 4.7%, p = 0.90), risk of all-cause death (OCT 2.7% vs IVUS 1.7%, p = 0.44), myocardial infarction (OCT 1.5% vs IVUS 1.3%, p = 0.76), stent thrombosis (OCT 0.3% vs IVUS 0.4%, p = 0.66) and target lesion revascularization (OCT 2.2% vs IVUS 2.6%, p = 0.58) between the 2 groups ( Figures 1 , 2 ). Heterogeneity was low in all outcomes (I 2 = 0).
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