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

Abstract Background Intracoronary imaging modalities, including intravascular ultrasound (IVUS) and optical coherence tomography (OCT), provide valuable supplemental data unavailable on coronary angiography (CA) and have shown to improve clinical outcomes. We sought to compare the clinical efficacy of IVUS, OCT, and conventional CA‐guided percutaneous coronary interventions (PCI). Methods Frequentist and Bayesian network meta‐analyses of randomized clinical trials were performed to compare clinical outcomes of PCI performed with IVUS, OCT, or CA alone. Results A total of 28 trials comprising 12,895 patients were included. IVUS when compared with CA alone was associated with a significantly reduced risk of major adverse cardiovascular events (MACE) (risk ratio: [RR] 0.74, 95% confidence interval: [CI] 0.63–0.88), cardiac death (RR: 0.64, 95% CI: 0.43–0.94), target lesion revascularization (RR: 0.68, 95% CI: 0.57–0.80), and target vessel revascularization (RR: 0.64, 95% CI: 0.50–0.81). No differences in comparative clinical efficacy were found between IVUS and OCT. Rank probability analysis bestowed the highest probability to IVUS in ranking as the best imaging modality for all studied outcomes except for all‐cause mortality. Conclusion Compared with CA, the use of IVUS in PCI guidance provides significant benefit in reducing MACE, cardiac death, and revascularization. OCT had similar outcomes to IVUS, but more dedicated studies are needed to confirm the superiority of OCT over CA.