Clinical Outcomes Following Optical Coherence Tomographic versus Intravascular Ultrasound-Guided Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials

Background Optical coherence tomography (OCT) and intravascular ultrasound (IVUS) are adjunctive intracoronary imaging modalities used for optimizing the implantation of coronary stents. However, the impact of the choice of OCT versus IVUS on clinical outcomes and periprocedural complications is unclear. Objective To perform a meta-analysis of all vetted randomized controlled trials comparing OCT-guided versus IVUS-guided percutaneous coronary intervention. Methods We queried MEDLINE, Cochrane Library, Scopus, and clinicalTrials.gov databases from their commencement to February 2024 for all randomized controlled trials that compared OCT-guided versus IVUS-guided percutaneous coronary interventions. The primary endpoint was major adverse periprocedural events (MAPE), a composite of stent thrombosis (ST), distal embolization (DE), and distal edge dissection (DED). The secondary endpoints included stent thrombosis, distal embolization, distal edge dissection, Major-adverse-cardiac events (MACE)-[a composite of cardiac death, Target vessel myocardial infarction (TVMI), and target vessel revascularization (TVR)], all-cause mortality, cardiac death, TVMI, TVR, and nonfatal stroke. The odds ratio (OR) with a 95% confidence interval (CI) was analyzed using a random-effect model. Results Seven randomized controlled trials were included in the analysis, and 4446 patients were enrolled. OCT was associated with lower MAPE (OR: 0.65, CI:0.47-0.91, p= 0.01) compared to IVUS. ST, DE, and DED were similar between OCT and IVUS. There were no significant differences in MACE (OR: 0.86, CI:0.64-1.16, p= 0.32), all-cause mortality (OR: 0.83, CI:0.42-1.66, p= 0.60), Cardiac death (OR: 0.62, CI:0.20-1.89, p= 0.40), TVMI (OR: 0.69, CI:0.33-1.46, p= 0.33), TVR, (OR: 1.09, CI:0.70-1.71, p= 0.70), and non-fatal stroke (OR: 1.82, CI:0.67-4.95, p= 0.24) one year following the index procedure. Conclusion Optical coherence tomographic-guided PCI was associated with lower major adverse peri-procedural events (MAPE), including stent thrombosis, distal embolization, and distal edge dissection, compared to intravascular ultrasound-guided PCI. However, there was no difference in overall major adverse cardiac events, target vessel myocardial infarction, target vessel revascularization, and nonfatal stroke.