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<p><?tk 4?>Percutaneous coronary angiography remains the gold standard for diagnosing and guiding treatment of epicardial coronary artery disease. However, whether adjunctive optical coherence tomography (OCT) improves clinical outcomes compared with angiography-guided percutaneous coronary intervention (PCI) remains uncertain. We performed a PRISMA-compliant systematic review and meta-analysis of randomized controlled trials comparing OCT-guided versus angiography-guided PCI. Cardiovascular mortality and stent thrombosis were the primary endpoints. Secondary endpoints included major adverse cardiovascular events (MACE), all-cause mortality, myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), and minimal stent area (MSA). Ten randomized trials enrolling 6,472 patients were included (3,235 OCT-guided; 3,237 angiography-guided). OCT-guided PCI was associated with significant reductions in cardiovascular mortality (RR 0.54; 95% CI 0.33–0.89; p = 0.01), trial-defined MACE (RR 0.76; 95% CI 0.65–0.89; p &lt; 0.01), and stent thrombosis (RR 0.53; 95% CI 0.33–0.87; p = 0.01). No significant differences were observed in minimal stent area (SMD 0.59; 95% CI − 0.19 to 1.37; p = 0.13), all-cause mortality (RR 0.73; 95% CI 0.52–1.04; p = 0.07), MI (RR 0.82; 95% CI 0.66–1.02; p = 0.07), TVR (RR 0.71; 95% CI 0.30–1.70; p = 0.44), or TLR (RR 0.73; 95% CI 0.43–1.24; p = 0.24). OCT-guided PCI is associated with reductions in trial-defined MACE and cardiovascular mortality, potentially mediated by lower stent thrombosis rates, without significant differences in MSA, all-cause mortality, new onset MI, TVR, or TLR. MSA, all-cause mortality, new onset MI, TVR, or TLR.</p> Graphical Abstract <p><?tk 4?>Optical Coherence Tomography Versus Angiography-Guided Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis. This meta-analysis of 10 randomized trials (n = 6,472) compared OCT-guided versus angiography-guided PCI. OCT guidance was associated with significant reductions in cardiovascular mortality (RR 0.54, 95% CI 0.33–0.89), stent thrombosis (RR 0.53, 95% CI 0.33–0.87), and trial-defined MACE (RR 0.76, 95% CI 0.65–0.89). No significant differences were observed in all-cause mortality, myocardial infarction, TLR, or TVR. OCT-guided PCI was associated with improved selected cardiovascular outcomes.</p> <p></p>

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Optical coherence tomography versus angiography guided percutaneous coronary intervention: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2026年4月17日

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  • Zeeshan Sattar,
  • Mohammad Hamza,
  • Junaid Mir,
  • Asad Ur Rab,
  • Safia Shaikh,
  • Syed Murtaza Ishaq,
  • Prakash Upreti,
  • Astha Upadhyaya,
  • Ali Awad,
  • Muhammad Burhan,
  • Farhan Sattar,
  • Karthik Gonuguntla,
  • Ramesh Daggubati,
  • Yasar Sattar,
  • M. Chadi Alraies,
  • M. Akram Kawsara

摘要

Percutaneous coronary angiography remains the gold standard for diagnosing and guiding treatment of epicardial coronary artery disease. However, whether adjunctive optical coherence tomography (OCT) improves clinical outcomes compared with angiography-guided percutaneous coronary intervention (PCI) remains uncertain. We performed a PRISMA-compliant systematic review and meta-analysis of randomized controlled trials comparing OCT-guided versus angiography-guided PCI. Cardiovascular mortality and stent thrombosis were the primary endpoints. Secondary endpoints included major adverse cardiovascular events (MACE), all-cause mortality, myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), and minimal stent area (MSA). Ten randomized trials enrolling 6,472 patients were included (3,235 OCT-guided; 3,237 angiography-guided). OCT-guided PCI was associated with significant reductions in cardiovascular mortality (RR 0.54; 95% CI 0.33–0.89; p = 0.01), trial-defined MACE (RR 0.76; 95% CI 0.65–0.89; p < 0.01), and stent thrombosis (RR 0.53; 95% CI 0.33–0.87; p = 0.01). No significant differences were observed in minimal stent area (SMD 0.59; 95% CI − 0.19 to 1.37; p = 0.13), all-cause mortality (RR 0.73; 95% CI 0.52–1.04; p = 0.07), MI (RR 0.82; 95% CI 0.66–1.02; p = 0.07), TVR (RR 0.71; 95% CI 0.30–1.70; p = 0.44), or TLR (RR 0.73; 95% CI 0.43–1.24; p = 0.24). OCT-guided PCI is associated with reductions in trial-defined MACE and cardiovascular mortality, potentially mediated by lower stent thrombosis rates, without significant differences in MSA, all-cause mortality, new onset MI, TVR, or TLR. MSA, all-cause mortality, new onset MI, TVR, or TLR.

Graphical Abstract

Optical Coherence Tomography Versus Angiography-Guided Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis. This meta-analysis of 10 randomized trials (n = 6,472) compared OCT-guided versus angiography-guided PCI. OCT guidance was associated with significant reductions in cardiovascular mortality (RR 0.54, 95% CI 0.33–0.89), stent thrombosis (RR 0.53, 95% CI 0.33–0.87), and trial-defined MACE (RR 0.76, 95% CI 0.65–0.89). No significant differences were observed in all-cause mortality, myocardial infarction, TLR, or TVR. OCT-guided PCI was associated with improved selected cardiovascular outcomes.