Clinical Outcomes Following Optical Coherence Tomographic Versus Intravascular Ultrasound‐Guided Percutaneous Coronary Intervention: A Meta‐Analysis of Randomized Controlled Trials

ABSTRACT Background Optical coherence tomography (OCT) and intravascular ultrasound (IVUS) are adjunctive intracoronary imaging modalities used to optimize coronary stent implantation. However, the impact of OCT versus IVUS on clinical outcomes and periprocedural complications is unclear. Aims To perform a meta‐analysis of all vetted randomized controlled trials comparing OCT‐guided versus IVUS‐guided percutaneous coronary intervention. Methods We queried MEDLINE, Cochrane Library, Scopus, and clinicalTrials.gov databases from their commencement to February 2024 for all randomized controlled trials that compared OCT‐guided versus IVUS‐guided percutaneous coronary interventions. The primary endpoint was major adverse periprocedural events (MAPE), a composite of stent thrombosis (ST), distal embolization (DE), and distal edge dissection (DED) at 30 days. The secondary endpoints included ST, DE, DED, major adverse cardiac events (MACE)—(a composite of cardiac death, target vessel myocardial infarction TVMI], and target vessel revascularization [TVR]), all‐cause mortality, cardiac death, TVMI, TVR, and nonfatal stroke at 1 year. The odds ratio (OR) with a 95% confidence interval (CI) was analyzed using a random‐effect model. Results Seven randomized controlled trials were included in the analysis, and 4446 patients were enrolled. OCT was associated with lower MAPE (OR: 0.65, CI: 0.47–0.91, p = 0.01) compared to IVUS. ST, DE, and DED were similar between OCT and IVUS at 30 days. There were no significant differences in MACE (OR: 0.86, CI: 0.64–1.16, p = 0.32), all‐cause mortality (OR: 0.83, CI: 0.42–1.66, p = 0.60), Cardiac death (OR:0.62, CI: 0.20–1.89, p = 0.40), TVMI (OR: 0.69, CI: 0.33–1.46, p = 0.33), TVR, (OR: 1.09, CI: 0.70–1.71, p = 0.70), and Nonfatal stroke (OR: 1.82, CI: 0.67–4.95, p = 0.24) 1 year following the index procedure. Conclusion Optical coherence tomographic‐guided PCI was associated with lower MAPE, defined as a composite of ST, DE, and DED, compared to IVUS‐guided PCI at 30 days of the index procedure. However, there was no difference in overall MACE, TVMI, TVR, and nonfatal stroke at 1 year.