Coronary Angiography, Intravascular Ultrasound, and Optical Coherence Tomography for Guiding of Percutaneous Coronary Intervention: A Systematic Review and Network Meta-Analysis
Authors' conclusion
IVI-guided PCI was associated with a reduction in ischemia-driven target lesion revascularization compared with ICA-guided PCI, with the difference most evident for IVUS. In contrast, no significant differences in myocardial infarction were observed between guidance strategies.
Study context
- Population
- Patients undergoing percutaneous coronary intervention (PCI) in trials comparing at least 2 guidance strategies among invasive coronary angiography (ICA), intravascular ultrasound (IVUS) and optical coherence tomography (OCT)
- Participants
- 15,489 patients · 24 RCTs
- Comparison
- IVUS-guided vs OCT-guided vs angiography-guided PCI
- Outcome
- Target lesion revascularization and MI (coprimary)
Methodological detailsfrequentist random-effects, Bayesian random-effects replication
- Frequentist random-effects
- Bayesian random-effects replication
Pooled result
As reported in the abstract
Odds ratio (95% CI)
IVUS vs ICAtarget lesion revascularization
0.69(0.54–0.87)
OCT vs ICAtarget lesion revascularization
0.83(0.63–1.09)
OCT vs IVUStarget lesion revascularization
1.21(0.88–1.66)
IVUS vs ICAMI
0.91(0.70–1.19)
OCT vs ICAMI
0.87(0.68–1.11)
OCT vs IVUSMI
0.96(0.69–1.33)
Further pooled results
| Outcome | OR (95% CI) | |
|---|---|---|
| Stent thrombosis · only in the frequentist analysis | 0.49 (0.26–0.92) | |
| 0.20.5125Odds ratio (log scale) |
Ischemia-driven target lesion revascularization, target vessel MI, target vessel revascularization
- Consistent with the coprimary outcome results
Survival
- Uncertain across analyses for IVUS or OCT vs ICA
Pairwise meta-analyses intravascular imaging (IVI) vs ICA (25 RCTs, 17 128 patients)
- IVI guidance associated with reduced target lesion revascularization, cardiac death and stent thrombosis
Original publication
Coronary Angiography, Intravascular Ultrasound, and Optical Coherence Tomography for Guiding of Percutaneous Coronary Intervention: A Systematic Review and Network Meta-Analysis. Circulation. Published 12 February 2024. doi:10.
Summarised from the published abstract; every number is checked against it