Intracoronary Imaging-Guided Percutaneous Coronary Intervention: An Updated Meta-Analysis of Randomized Trials
Authors' conclusion
In this updated meta-analysis of RCTs, after accounting for modifier effects from recent studies, ICI-guided PCI was associated with significantly reduced cardiovascular events compared with angiography-guided PCI. Geographic heterogeneity across trials was present mainly for target vessel revascularization, explained in large part by differences in lesion characteristics and procedural technique.
Study context
- Population
- Patients undergoing percutaneous coronary intervention (PCI) in the drug-eluting stent era
- Participants
- 24,634 patients28 randomized controlled trials (RCTs)
- Comparison
- Intracoronary imaging (ICI)-guided PCI vs angiography-guided PCI
- Outcome
- Target lesion failure, cardiac mortality, MI, target vessel revascularization, stent thrombosis and all-cause mortality
- Follow-up
- Mean 22 months
Methodological detailstrial sequential analysis, fragility analysis, Bayesian meta-analysis, meta-regression
- Trial sequential analysis
- Fragility analysis
- Bayesian meta-analysis
- Meta-regression
Pooled result
As reported in the abstract
ICI-guided PCI vs Angiography-guided PCIRelative risk (95% CI)
Target lesion failure; I2 = 61%
0.72(0.61–0.85)
Cardiac mortality; I2 = 5%
0.73(0.58–0.91)
MI; I2 = 0%
0.86(0.75–0.97)
Target vessel revascularization; I2 = 41%
0.69(0.57–0.83)
Stent thrombosis; I2 = 0%
0.55(0.40–0.76)
All-cause mortality; I2 = 0%
0.82(0.70–0.96)
Further pooled results
Trial sequential, fragility and Bayesian analyses
- Fragility index range
- 9 to 50
- Posterior probability for benefit, all outcomes
- >99%
- Trial sequential analysis confirmed at least a 20% reduction in all outcomes with ICI-guided PCI
Between-trial heterogeneity (meta-regression)
- Geography and lesion characteristics explained most between-trial variance (residual tau)
- 0
Original publication
Intracoronary Imaging-Guided Percutaneous Coronary Intervention: An Updated Meta-Analysis of Randomized Trials. J Am Coll Cardiol. Published 10 September 2026. doi:10.
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