Comparison of Long-Term Outcomes Between Intravascular Ultrasound-, Optical Coherence Tomography- and Angiography-Guided Stent Implantation: A Meta-Analysis

Abstract

Intravascular ultrasonography (IVUS) and optical coherence tomography (OCT) guided percutaneous coronary interventions (PCI) are alternative techniques to angiography-guided (ANG-g) PCI in patients with coronary artery disease (CAD), especially for optimal stent deployment in coronary arteries. We conducted a network meta-analysis including studies comparing those three techniques. We searched databases for studies that compared IVUS, OCT, and ANG-g PCI in patients with CAD. Overall, 52 studies with 231,137 patients were included in this meta-analysis. ANG-g PCI had higher major adverse cardiovascular events (MACEs), all-cause death, cardiac death, myocardial infarction (MI), target lesion revascularization (TLR), and stent thrombosis (ST) than IVUS-guided PCI. Of note, both OCT-guided and IVUS-guided PCI had similar outcomes. The frequency of MACEs, cardiac death, and MI were higher in ANG-g PCI than in OCT-guided PCI. The highest benefit was established with OCT for MACEs (P-score=.973), MI (P-score=.823), and cardiac death (P-score=.921) and with IVUS for all-cause death (P-score=.792), TLR (P -score=.865), and ST (P-score=.930). This network meta-analysis indicated that using OCT or IVUS for optimal stent implantation provides better outcomes in comparison with ANG-g in patients with CAD undergoing PCI.

Optical coherence tomography-guided vs. intravascular ultrasound-guided percutaneous coronary intervention: a systematic review and meta-analysis of randomized controlled trials

“…These findings align with previous analyses comparing the same outcomes between the two modalities (3)(4)(5)18), although there has been some indication that IVUS might be the better imaging modality (3). Nevertheless, the prior meta-analyses suffered from many limitations, including indirect comparisons, the incorporation of observational studies (which confer the risk of confounding bias), and the inclusion of only a few small RCTs, which provided low statistical power.…”

“…The finer resolution and image quality of both OCT and IVUS allow for a better understanding of luminal anatomy, plaque location, and precise vessel dimensions, which allow for improved stent sizing and positioning (19,20). Their improved ability to discern stent malpositioning, under-expansion, and edge dissection elucidates the improved clinical outcomes compared to conventional angiographic guidance (3,4). However, when compared to each other, our findings show no evidence of superior clinical benefit of either OCT or IVUS.…”

“…Recently, optical coherence tomography (OCT) and intravascular ultrasound (IVUS) have emerged as valuable tools capable of overcoming several limitations associated with coronary angiography (1). Multiple studies have indicated that IVUS-and OCT-guided PCI yield better clinical outcomes, including reduced cardiac mortality and major adverse cardiac events (MACE), compared to coronary angiography-guided PCI (3)(4)(5). IVUS optimizes and guides stent placement by providing enhanced information regarding vessel lumen dimensions, plaque characteristics, overall plaque burden, and the extent of calcification (6).…”

“…While multiple trials have focused on establishing the superiority of IVUS and OCT compared to coronary angiography alone, only a limited number of studies have compared OCT directly to IVUS. Previous meta-analyses have largely focused on indirect comparisons to determine which imaging modality is superior to the other (3,4) and, in some cases, have also included observational studies that provide a poorer quality of evidence (4,5). Recently, the results of the largest trial to date addressing this question, the OCTIVUS trial (2,008 patients), have been published (8).…”