Optical Coherence Tomography-Guided vs. Angiography-Guided Percutaneous Coronary Intervention for Complex Coronary Lesions: A Systematic Review and Meta-Analysis
Muhammad Hamza Shuja,
Muhammad Ahmed,
Ramish Hannat,
Laiba Khurram,
Hamza Ali Hasnain Sheikh,
Syed Hasan Shuja,
Adarsh Raja,
Jawad Ahmed,
Kriti Soni,
Shariq Ahmad Wani,
Aman Goyal,
Bala Pushparaji,
Ali Hasan,
Raheel Ahmed,
Hritvik Jain
Affiliations
Muhammad Hamza Shuja
Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan
Muhammad Ahmed
Department of Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi 75660, Pakistan
Ramish Hannat
Department of Internal Medicine, Services Institute of Medical Sciences, Lahore 54000, Pakistan
Laiba Khurram
Department of Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi 75660, Pakistan
Hamza Ali Hasnain Sheikh
Department of Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi 75660, Pakistan
Syed Hasan Shuja
Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan
Adarsh Raja
Department of Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi 75660, Pakistan
Jawad Ahmed
Department of Internal Medicine, Northwest Health—Porter, Valparaiso, IN 46383, USA
Kriti Soni
Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, USA
Shariq Ahmad Wani
Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI 48202, USA
Aman Goyal
Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
Bala Pushparaji
Department of Cardiology, MetroHealth Medical Center, Cleveland, OH 44109, USA
Ali Hasan
Department of Cardiology, National Heart and Lung Institute, Imperial College London, London SW7 2AZ, UK
Raheel Ahmed
Department of Cardiology, National Heart and Lung Institute, Imperial College London, London SW7 2AZ, UK
Hritvik Jain
Department of Cardiology, All India Institute of Medical Sciences, Jodhpur 342005, India
Background: Despite advances in coronary artery disease (CAD) treatment, challenges persist, particularly in complex lesions. While percutaneous coronary intervention (PCI) is widely used, its outcomes can be affected by complications like restenosis. Optical coherence tomography (OCT), offering higher-resolution imaging than angiography, shows promise in guiding PCI. However, meta-analytical comparisons between OCT-guided and angiography-guided PCI remain limited. Methods: Databases, including PubMed, Scopus, Cochrane Library, and ClinicalTrials.gov, were queried through May 2025 to identify randomized controlled trials (RCTs) comparing OCT-guided PCI with angiography-guided PCI. Data were pooled using risk ratios (RRs) and mean difference (MD) with 95% confidence intervals (CIs) in a random-effects model. Results: Five RCTs involving 5737 patients (OCT: 2738 and angiography: 2999) were included. On pooled analysis, OCT-guided PCI was associated with a notable reduction in major adverse cardiovascular event (MACE) (RR: 0.71, p = 0.0001), cardiac mortality (RR: 0.43, p = 0.003), target lesion revascularization (TLR) (RR: 0.53, p = 0.007), and stroke (RR: 0.17, p = 0.02), compared to angiography-guided PCI. No significant differences were noted for all-cause mortality and myocardial infarction. Conclusions: In patients with complex coronary lesions, OCT-guided PCI reduces the risk of MACE, cardiac mortality, TLR, and stroke, compared to angiography-guided PCI only. This study supports incorporating advanced imaging techniques like OCT to improve clinical outcomes, especially in complex PCIs.
