Jiayi Luo, Yu Xue, Zimin Xu, Kai Xu, Yang Li, Yaling Han
{"title":"Optical coherence tomography-guided <i>vs</i>. coronary angiography-guided percutaneous coronary intervention: a systematic review and meta-analysis.","authors":"Jiayi Luo, Yu Xue, Zimin Xu, Kai Xu, Yang Li, Yaling Han","doi":"10.21037/qims-24-1628","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The superiority of optical coherence tomography (OCT) guidance over coronary angiography (CA) guidance in optimizing therapy in patients undergoing percutaneous coronary intervention (PCI) remains uncertain. Consequently, we conducted a comprehensive meta-analysis with the objective of providing a higher level of evidence.</p><p><strong>Methods: </strong>The databases of PubMed/Medline, Embase, and Cochrane Central were searched in March 2024. The outcomes of this meta-analysis included all-cause death, cardiovascular death, major adverse cardiovascular events (MACE), restenosis, myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), post-intervention minimum stent area (MSA), post-intervention minimum lumen diameter (MLD), and follow-up MLD. Statistical analysis was conducted using RevMan 5.3 and STATA version 18. The degree of heterogeneity was evaluated using the I<sup>2</sup> statistical test. When I<sup>2</sup> exceeded 50%, heterogeneity was deemed to be substantial, prompting the application of a random effects model; conversely, a fixed effects model was employed. The results were expressed as risk ratio (RR) and mean deviation (MD) with their corresponding 95% confidence interval (CI).</p><p><strong>Results: </strong>A total of 25 articles were included in the study. In terms of clinical outcomes, OCT-guided PCI was associated with a significant reduction in all-cause death (RR =0.62; 95% CI: 0.47-0.83; P=0.001), cardiovascular death (RR =0.47; 95% CI: 0.32-0.69; P<0.0001), and MACE (RR =0.65; 95% CI: 0.54-0.77; P<0.00001). Meanwhile, no statistically significant differences were observed for restenosis (RR =0.91; 95% CI: 0.73-1.13; P=0.38), MI (RR =0.83; 95% CI: 0.69-1.00; P=0.05), TLR (RR =0.86; 95% CI: 0.66-1.10; P=0.23), and TVR (RR =0.82; 95% CI: 0.63-1.07; P=0.15). In terms of surrogate endpoints, OCT-guided PCI was associated with a significant enhancement of MSA (MD =0.30; 95% CI: 0.04-0.56; P=0.03) and MLD at follow-up (MD =0.12; 95% CI: 0.02-0.22; P=0.02). Nevertheless, no significant increase in the post-intervention MLD was observed (MD =0.04; 95% CI: -0.02 to 0.10; P=0.19).</p><p><strong>Conclusions: </strong>Compared with CA, the use of OCT for PCI guidance may be an effective strategy to optimize treatment.</p>","PeriodicalId":54267,"journal":{"name":"Quantitative Imaging in Medicine and Surgery","volume":"15 3","pages":"2246-2257"},"PeriodicalIF":2.9000,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948425/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Quantitative Imaging in Medicine and Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.21037/qims-24-1628","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/2/26 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
引用次数: 0
Abstract
Background: The superiority of optical coherence tomography (OCT) guidance over coronary angiography (CA) guidance in optimizing therapy in patients undergoing percutaneous coronary intervention (PCI) remains uncertain. Consequently, we conducted a comprehensive meta-analysis with the objective of providing a higher level of evidence.
Methods: The databases of PubMed/Medline, Embase, and Cochrane Central were searched in March 2024. The outcomes of this meta-analysis included all-cause death, cardiovascular death, major adverse cardiovascular events (MACE), restenosis, myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), post-intervention minimum stent area (MSA), post-intervention minimum lumen diameter (MLD), and follow-up MLD. Statistical analysis was conducted using RevMan 5.3 and STATA version 18. The degree of heterogeneity was evaluated using the I2 statistical test. When I2 exceeded 50%, heterogeneity was deemed to be substantial, prompting the application of a random effects model; conversely, a fixed effects model was employed. The results were expressed as risk ratio (RR) and mean deviation (MD) with their corresponding 95% confidence interval (CI).
Results: A total of 25 articles were included in the study. In terms of clinical outcomes, OCT-guided PCI was associated with a significant reduction in all-cause death (RR =0.62; 95% CI: 0.47-0.83; P=0.001), cardiovascular death (RR =0.47; 95% CI: 0.32-0.69; P<0.0001), and MACE (RR =0.65; 95% CI: 0.54-0.77; P<0.00001). Meanwhile, no statistically significant differences were observed for restenosis (RR =0.91; 95% CI: 0.73-1.13; P=0.38), MI (RR =0.83; 95% CI: 0.69-1.00; P=0.05), TLR (RR =0.86; 95% CI: 0.66-1.10; P=0.23), and TVR (RR =0.82; 95% CI: 0.63-1.07; P=0.15). In terms of surrogate endpoints, OCT-guided PCI was associated with a significant enhancement of MSA (MD =0.30; 95% CI: 0.04-0.56; P=0.03) and MLD at follow-up (MD =0.12; 95% CI: 0.02-0.22; P=0.02). Nevertheless, no significant increase in the post-intervention MLD was observed (MD =0.04; 95% CI: -0.02 to 0.10; P=0.19).
Conclusions: Compared with CA, the use of OCT for PCI guidance may be an effective strategy to optimize treatment.
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