Optical coherence tomography-guided percutaneous coronary intervention compared with other imaging guidance: a meta-analysis

Abstract

The use of optical coherence tomography (OCT) in PCI guidance is limited perhaps by the lack of adequately powered studies which compare its efficacy and outcomes to the other more popular imaging modalities. We therefore performed a meta-analysis to compare clinical outcomes following OCT-guided PCI with the other imaging modalities in two separate comparisons. We abstracted data from randomized control trials and observational comparative studies focusing on OCT versus either angiography- or IVUS-guided PCI outcomes identified following a systematic search (April 2006 and May 2017). This meta-analysis included a total of 2781 patients; OCT-guidance versus Angiography guidance (n = 1753) and OCT-guidance versus IVUS-guidance (n = 1028). Pooled estimates of outcomes, presented as odds ratios (OR) [95% confidence intervals], were generated with random-effect models. OCT guidance showed lower rates of MACE (OR 0.70 [0.49, 1.00] p = 0.05) and cardiac deaths (OR 0.40 [0.18, 0.90] p = 0.03) compared to Angiography-guidance alone but no statistical significant results for myocardial infarction (OR 0.70 [0.42, 1.16] p = 0.17), stent thrombosis (OR 1.17 [0.40, 3.43] p = 0.77) and target lesion revascularizations (OR 1.07 [0.48, 2.38] p = 0.86).No statistical significance was observed in the OCT versus IVUS comparison; MACE (OR 0.89 [0.46, 1.73] p = 0.73), cardiac deaths (OR 0.56 [0.12, 2.70] p = 0.47), MI (OR 0.56 [0.12, 2.70] p = 0.47), ST (OR 0.43 [0.06, 2.95] p = 0.39), and TLR(OR 0.99 [0.45, 2.18] p = 0.99). OCT-guided PCI in comparison with angiography-guided was associated with reduction in adverse events for the composite of cardiac deaths, myocardial infarction and repeat revascularizations. There was no statistically significant difference in clinical outcomes observed in the comparison between OCT- and IVUS-guidance.

Outcomes of intravascular ultrasound versus optical coherence tomography guided percutaneous coronary angiography: A meta regression‐based analysis

“…[19][20][21] Previous meta-analyses have explored the impact of IVUS and OCT but were underpowered because of the limited number of studies present. 25,26 Extending the role of intracoronary imaging, the current meta-analysis provides convincing evidence that OCT and IVUS guided PCI have equivalent clinical cardiovascular outcomes. These findings from the current meta-analysis are in concordance with the recent results of MISTIC-1, ILUMIEN III: OPTIMIZE PCI trials, and iSIGHT trials.…”

JCS/JSCVS 2018 Guideline on Revascularization of Stable Coronary Artery Disease

“…The benefit of OCT/OFDI guidance on the clinical outcomes of PCI is greater than that of angiography guidance and possibly equal to that of IVUS guidance. 931, [943][944][945][946][947][948] As with IVUS, routine OCT/OFDI in all PCI is not recom- In addition, OCT/OFDI may help identify the cause of complications, thrombosis, and restenosis associated with PCI. Minimum stent area and lipid-rich plaque at the stent edge immediately after stent placement are indicated as predictors of late repeat revascularization.…”

Management of calcified coronary artery bifurcation lesions

“…In contrast, optical coherence tomography (OCT) does permit estimation of calcium depth and volume 18,21 . A meta‐analysis suggested reduced risk of cardiac death, MI, and repeat revascularization with the use of OCT during PCI compared to IVUS 22 . Total calcium arc >180° by IVUS or OCT, and increased calcium thickness >0.5 mm on OCT have been reported as risk factors for stent underexpansion 23 .…”