Optical frequency domain imaging versus intravascular ultrasound for percutaneous coronary intervention: a meta-analysis and trial sequential analysis of randomized controlled trials.

Intravascular ultrasound (IVUS) or optical frequency domain imaging (OFDI) for guiding percutaneous coronary interventions (PCI) reduces the risk of adverse events compared with angiographic guidance. However, only a few trials compared both modalities. This study aims to assess and compare OFDI- vs. IVUS-guided PCI. We conducted a meta-analysis of randomized controlled trials (RCTs) retrieved from PubMed, Scopus, WOS, Embase, and Cochrane Library till September 2024. The primary outcome was major adverse cardiac events (MACE). Risk ratios (RR) were applied for dichotomous outcomes and mean differences (MD) for continuous outcomes, both with 95% confidence intervals (CI). PROSPERO ID: CRD42024595477. Four RCTs with 1135 patients were included. There was no significant difference between the two modalities in terms of MACE [RR: 0.99; 95% CI: (0.53, 1.86); P = 0.98], all-cause mortality [RR: 0.72; 95% CI: (0.15, 3.56); P = 0.69], cardiac mortality [RR: 1.00; 95% CI: (0.18, 5.68); P = 1.00] and myocardial infarction [RR: 1.21; 95% CI: (0.35, 4.18); P = 0.76]. Additionally, there was no significant difference in PCI success [RR: 1.00; 95% CI: (0.99, 1.02); P = 0.64]. However, OFDI was associated with a significant increase in contrast volume [MD: 19.81 ml; 95% CI: (2.53, 37.09); P = 0.02] and reduction in fluoroscopy time [MD: -7.05 min; 95% CI: (-9.32, -4.79); P < 0.01]. This meta-analysis of RCTs suggests that OFDI is comparable to IVUS in efficacy and safety for guiding PCI, with no significant differences in clinical outcomes. These findings support the use of either modality for PCI guidance. However, additional large-scale, multicenter RCTs to recommended to validate these findings and enhance their generalizability.