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

Abstract

Background: Studies comparing clinical outcomes with intravascular ultrasound (IVUS) versus optical coherence tomography (OCT) guidance for percutaneous coronary intervention (PCI) in patients presenting with coronary artery disease, including stable angina or acute coronary syndrome, are limited. Methods:We performed a detailed search of electronic databases (PubMed, Embase, and Cochrane) for randomized controlled trials and observational studies that compared cardiovascular outcomes of IVUS versus OCT. Data were aggregated for the primary outcome measure using the random-effects model as pooled risk ratio (RR).The primary outcome of interest was major adverse cardiac events (MACE), cardiac mortality, and all-cause mortality. Secondary outcomes included myocardial infarction (MI), stent thrombosis (ST), target lesion revascularization (TLR), and stroke.Results: A total of seven studies met the inclusion criteria, comprising 5917 patients (OCT n = 2075; IVUS n = 3842). OCT-PCI versus IVUS-guided PCI comparison yielded no statistically significant results for all the outcomes; MACE (RR 0.

Comparison of intravascular ultrasound, optical coherence tomography, and conventional angiography‐guided percutaneous coronary interventions: A systematic review, network meta‐analysis, and meta‐regression

“…Kuku et al pooled data from three RCTs and three observational studies and reported no difference in MACE, cardiac death, MI, TLR, or stent thrombosis between IVUS and OCT 47 . In a more recent meta‐analysis, Sattar et al combined data from four RCTs and three observational studies and found no significant differences between OCT and IVUS across outcomes 40 . Recent trials like the Optical Coherence Tomography Versus Intravascular Ultrasound and Angiography to Guide Percutaneous Coronary Interventions (iSIGHT) trial, the Optical Coherence Tomography Compared with Intravascular Ultrasound and with Angiography to Guide Coronary Stent Implantation (ILUMIEN‐III) trial, and the Optical Frequency Domain Imaging versus Intravascular Ultrasound in Percutaneous Coronary Intervention (OPINION) trial also showed the noninferiority of OCT to IVUS 1,6–9 .…”

“…While many previous meta‐analyses have shown that IVUS‐guided PCI improves outcomes when compared with CA alone, 36–39 our study is unique in that our findings are solely based on RCTs, which are less influenced by unmeasured confounders and selection bias associated with observational studies. Sattar et al and Siddqi et al recently published meta‐analyses on similar topics, but they only included 7 and 13 studies, respectively, about half of which consisted of observational studies 40,41 . In contrast, we incorporated 28 RCTs and produced more robust results by generating network meta‐analyses models under both frequentist and Bayesian frameworks, unlike conventional pairwise meta‐analyses which solely use direct evidence.…”

“…46 Kuku et al pooled data from three RCTs and three observational studies and reported no difference in MACE, cardiac death, MI, TLR, or stent thrombosis between IVUS and OCT. 47 In a more recent meta-analysis, Sattar et al combined data from four RCTs and three observational studies and found no significant differences between OCT and IVUS across outcomes. 40 42 A more recent meta-analysis of six RCTs and five observational studies also did not identify any differences in clinical outcomes, including all-cause mortality, MACE, MI, TLR, TVR, and stent thrombosis. 48 In our analysis, the use of FFR in the CA arm may have diluted the comparative efficacy of OCT in the FORZA trial, but sensitivity analysis excluding trials that used FFR also produced similar results.…”

“…Sattar et al and Siddqi et al recently published meta-analyses on similar topics, but they only included 7 and 13 studies, respectively, about half of which consisted of observational studies. 40,41 In contrast, we incorporated 28 RCTs and produced more robust results by generating network meta-analyses models under both frequentist and Bayesian frameworks, unlike conventional pairwise meta-analyses which solely use direct evidence. Importantly, we performed an updated network meta-analysis incorporating additional 5 years of data from the last network meta-analysis on this subject 42 to compare the three imaging modalities.…”

Intracoronary Imaging of Coronary Atherosclerotic Plaque: From Assessment of Pathophysiological Mechanisms to Therapeutic Implication

“…An observational study showed a significant difference in mortality between patients who underwent OCT-guided PCI compared with patients who underwent angiography-guided PCI (7.7% vs. 15.7%; p < 0.0001), confirmed also using multivariate Cox analysis (HR 0.48; 95% CI: 0.26 to 0.81; p = 0.001) and propensity matching analysis (HR 0.39; 95% CI: 0.21 to 0.77; p = 0.0008; OCT vs. angiography-alone cohort) [ 104 ]. A recent meta-analysis, encompassing seven studies for a total of 5917 patients, however, failed to demonstrate the superiority of OCT-guided PCI vs. IVUS-guided PCI for hard endpoint MACEs (RR 0.78; 95% CI, 0.57–1.09; p = 0.14) [ 105 ]. Stone and colleagues, finally, showed in the CANARY Trial that near-infrared spectroscopy can identify lipid-rich intracoronary plaques more prone to rupture after stent implantation, generally due to distal embolization [ 82 ].…”